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Out-of-Area Service

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals

Counties Covered

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

Health Net provides prior authorization, concurrent, retrospective utilization review, and care management assistance to members who receive care outside the service area. Health Net Utilization Management (UM) Department initiates concurrent and medical necessity review when applicable. Health Net then notifies the primary care physician (PCP) of the member's location and clinical condition. The UM Department in collaboration with the physician and the out-of-area provider determines if the member can safely be transferred. Members are encouraged to contact their PCP or participating physician group (PPG) to determine the best plan for obtaining medical care and follow-up.

Last Updated: 08/06/2021