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Out-of-Area Services

Provider Type

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

Health Net provides authorization, concurrent and retrospective utilization review, and care management assistance to members who receive emergency inpatient care outside their service area. Members are encouraged, when possible, to contact their primary care physician (PCP) or participating physician group (PPG) to determine the best plan for obtaining medical care and follow-up when out of the service area. When Health Net is contacted, the Utilization Management (UM) Department notifies the PPG of the member's location and clinical condition. The Health Net UM staff assists the member's PCP, PPG and receiving facility in determining whether the member, in the opinion of the treating provider, can safely be transferred to a Health Net participating facility provider. If it is determined that the member can be safely transferred, Health Net nurses assist as needed with the transfer.

Last Updated: 10/31/2019