Financial penalties may be imposed on Health Net by regulators if specified time limits are not met. Reasonable delays include Health Net experiencing the following:
- Has not received requested information reasonably necessary to determine the medical necessity of the services requested.
- Requires a consultation with an expert reviewer.
- Has requested an additional examination or test on the member (provided the test is reasonable and consistent with good medical practice).
Health Net is required to notify both the provider and member in writing about the delay, either immediately on expiration of the allowed time or as soon as Health Net becomes aware that it will not meet the time requirement, whichever comes first. The provider must also be notified initially by telephone.