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Instructions to Members Regarding Authorization

Provider Type

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

According to the Evidence of Coverage (EOC) or Certificate of Insurance (COI), members are required to adhere to the following instructions regarding emergency services and urgently needed care:

  • Emergency services do not require prior authorization; however, the member is required to notify their participating physician group (PPG), primary care physician (PCP) or Health Net as soon as possible so that follow-up care can be coordinated.
  • Hospitals are responsible for notifying Health Net of the admission of a Health Net member.
  • PPGs and PCPs are available 24 hours a day, seven days a week, to respond to member telephone calls regarding medical care that the member believes is needed immediately. The member's PPG or PCP should evaluate the member's situation and recommend where the member should obtain emergency or urgent care.
Last Updated: 10/30/2019