Coverage Explanation

Provider Type

  • Participating Physician Groups (PPG)
  • Hospitals     
  • Ancillary

Emergency care by any licensed provider is covered regardless of where services are performed. Emergency services may be provided inside and outside the Health Net Cal MediConnect service area. 

If a member receives emergency care at an out-of-network hospital and needs inpatient care after the emergency condition is stabilized, he or she must receive inpatient care at the out-of-network hospital as authorized by Health Net. The member must pay the cost-sharing amount he or she would pay at a network hospital.

For a member who is hospitalized in an out-of-network hospital and needs ongoing inpatient care, Health Net may offer to move the member to an in-network hospital once the member is stable and the attending physician indicated the member is stable for transfer; however, if the member refuses to be transferred, Health Net cannot move the member against his or her will.

Refer to definition of an emergency for more information.