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Denial of Investigational or Experimental Treatment

Provider Type

  • Participating Physician Groups (PPG)
  • Ancillary

Delegated participating providers are required to notify Health Net immediately of member requests or proposed services for expedited investigational or experimental treatment. PPGs must submit requests for experimental or investigational treatment to Health Net. Terminal illness is not a requirement for experimental or investigational treatment.

Definition of an expedited request is when a member, or any physician (regardless of whether the physician is affiliated with Health Net), requests that Health Net expedite a prior authorization when the member or his or her physician believes that waiting for a decision under the standard time frame could place the member's life, health or ability to regain maximum function in serious jeopardy.

Delegated Participating Providers Responsibilities

PPGs must immediately forward all pertinent documentation for investigational or experimental treatment service requests via fax to Health Net's Prior Authorization Department. Health Net's Prior Authorization Department has a dedicated fax number for processing prior authorization requests.

Last Updated: 10/30/2019