When Coverage Terminates While Member is Hospitalized
Provider Type
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
If Health Net coverage begins while the member is hospitalized, the prior carrier must continue coverage until one of the following occurs:
- Health plan benefits are exhausted before the member is discharged.
- The member is discharged from the hospital. If a member is confined to a hospital and is transferred to another hospital with no more than a 24-hour lapse in care, the confinement is a continuous hospital stay.
The prior carrier is responsible for covering the stay until the member is discharged from the hospital or moved to a non-acute, inpatient hospital level of care (for example, a skilled nursing facility (SNF) within the same hospital).
Health Net and the participating physician group (PPG) are liable after the member is discharged or transferred to a lower level of care.