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OB/GYN Self-Referrals

Provider Type

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

PPG Information

Health Net members have the right to self-refer for a screening mammography. In addition, members have direct access to participating women's health specialists for routine and preventive health care services provided as basic benefits.

If a member needs OB/GYN preventive care, is pregnant or has a gynecological concern, she may self-refer to an OB/GYN or family practice physician who provides such services within the member's participating physician group (PPG). If these services are not available within the PPG, the member may go to one of the PPG's referred physicians who provide OB/GYN services. Each PPG must be able to assist members by maintaining a list of its referral physicians. The OB/GYN consults with the member's PCP regarding the member's condition, treatment and any need for follow-up care.

Physician Information

A female member may obtain obstetrician and gynecologist (OB/GYN) services without first contacting her primary care physician (PCP). If the member needs OB/GYN preventive care, is pregnant or has a gynecological concern, she may self-refer to an OB/GYN or family practice physician who provides such services within Health Net's participating provider network.

If these services are not available within Health Net's participating provider network, Health Net authorizes services to a qualified non-participating provider of OB/GYN services in accordance with the Health Net prior authorization procedures.

The OB/GYN consults with the member's PCP regarding the member's condition, treatment and any need for follow-up care.

Last Updated: 10/31/2019