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Services Not Requiring Referral or Prior Authorization

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Sacramento
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

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
Last Updated: 03/30/2021