Continuity of Care
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Health Net offers continuity of care assistance for new Health Net members who are receiving care from a out-of-network practitioner for a current episode involving an acute, serious or chronic mental health condition. This determination takes into consideration the potential clinical effect on a member's treatment due to a provider change. If authorized, Health Net allows the member a reasonable transition period (subject to the benefit limit) to continue their course of treatment with the non-participating practitioner prior to transferring to a participating practitioner. Health Net authorizes services according to state and federal regulation.
Practitioners or Health Net members may request continuity of care assistance by contacting Health Net directly. Health Net customer service representatives obtain the information necessary to authorize care and then refer the call to a Health Net care manager. Care managers are licensed behavioral health professionals who authorize services and consult as needed with Health Net physician advisors. Health Net notifies the requesting practitioner, or Health Net member by phone of the continuity of care decision. Providers may print the Quick Reference Sheet (PDF) and hang it in their office for easy access to Health Net contact information.
Except for behavioral health and substance abuse services, all other covered services, including prescription medications, continue to be coordinated by the member's primary care physician (PCP). Providers treating members without behavioral health benefits should assess for behavioral health needs and refer as appropriate. Providers should consult with their participating physician group (PPG) for questions regarding participating behavioral health providers.