Services Not Requiring Referral or Prior Authorization
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Referral or prior authorization is not required for the following services. Members may obtain these services from any qualified in-network or out-of-network provider:
- Emergency services
- Family planning services (including visits to an OB/GYN for annual Pap test and pelvic examination)
- HIV testing
Prior authorization is not required for the following services (access requirements are indicated):
- Basic obstetric care, including Comprehensive Perinatal Services Program (CPSP) services - must be obtained from an in-network provider
- Preventive care - must be obtained from an in-network provider
- Department of Health Care Services (DHCS) -required immunizations when provided from the local health department (LHD) (LHD must submit immunization records with any claim)
- Sensitive or confidential services:
- Minor Consent Services.
- Therapeutic and elective pregnancy termination - may be obtained from any qualified in-network or out-of-network provider.
- Family planning, sexually transmitted infection (STI) diagnosis and treatment, HIV testing and counseling, and sexual assault services - may be obtained from any qualified in-network or out-of-network provider.
- Drug and alcohol abuse treatment and mental health treatment - these services are not covered by Health Net's Medi-Cal managed care plan and may be obtained through the county drug and alcohol program and the county mental health program.