Reimbursement Amount
Provider Type
- Physicians
The Health Net Provider Participation Agreement (PPA) specifies that contracting providers agree to accept the contract amount as payment in full for covered services. Payment is based on the rates in the PPA. Providers must use the correct codes for billing procedures, as stated in the PPA.
When a member receives covered services from a participating provider, the member is not financially responsible. The provider may not charge the member for any expenses except copayments or coinsurance or deductibles, if applicable.
The provider may not charge the member for medical services that Health Net has denied as not medically necessary, unless the member has agreed in writing to be responsible for payment of such charges prior to receiving services.