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Payment for Service of Non-Participating Providers

Provider Type

  • Physicians (does not apply to Cal MediConnect)
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Health Net and its participating physician groups (PPGs) must make timely and reasonable payment to, or on behalf of, Health Net members for the following covered services obtained from non-participating providers:

  • Ambulance services dispatched through 911 or its local equivalent.
  • Emergency and urgently needed services.
  • Maintenance and post-stabilization care services.
  • Renal dialysis services provided while the member was temporarily outside the service area.
  • Services for which coverage has been denied by Health Net and found upon appeal, to be services the member was entitled to have furnished, or paid for, by Health Net or the PPG.
  • Federally Qualified Health Center (FQHC) services if not available in Health Net's or its PPG's network.
Last Updated: 10/30/2019