Post Stabilization
Provider Type
- Participating Physician Groups (PPG)
Post-stabilization care (also referred to as maintenance care after an emergency medical condition) consists of services related to emergency medical conditions, that are provided after a member is and remains stabilized or, in certain cases, to improve or resolve the member's condition, from the time that the treating hospital requests authorization from Health Net until one of the following occurs:
- Member is discharged
- Primary care physician (PCP) arrives and assumes responsibility for the member's care
- Treating physician and Health Net agree to another arrangement
Coverage Explanation
The physician treating the member must decide when the member may be considered stabilized for transfer of discharge. For transfers from one inpatient setting to another inpatient setting, a member or the person authorized to act on their behalf who disregards the decision and believes the member cannot safely be transferred may request that Health Net or PPG pay for continued out-of-network services. If the request is denied, appeal rights must be provided to the member.
PPG Responsibility
When a facility contacts a participating physician group (PPG) with a request for post-stabilization services for a Health Net member, the PPG must immediately contact (or refer the call to) the Health Net Medical Management Department . Health Net then works closely with the attending physician or facility and the member's primary care physician (PCP) or PPG on continuity of care.
All PPGs are required to provide 24-hour on-call access to a physician to authorize and coordinate any necessary post-stabilization services.