- Participating Physician Groups (PPG)
If a Health Net PPO member suffers a job-related illness or injury and receives medical services, these services may be covered under California workers' compensation. Question the member for possible workers' compensation liability and enter information on the claim.
Workers' compensation does not apply to individual family plans, such as EnhancedCare PPO or Individual Family Plan PPO.
If the member has an approved workers' compensation claim, the provider should obtain the workers' compensation insurance information from the member and/or the member's employer and bill the appropriate workers' compensation carrier directly for payment. In the event that Health Net pays a claim on behalf of its member, and subsequently discovers that the member has an approved workers' compensation case, Health Net instructs the provider to bill the applicable workers' compensation carrier and refund Health Net.
In the event that the member's workers' compensation claim is contested by the employer, Health Net may file a lien against the member's workers' compensation benefits. In the interim, Health Net pays the covered charges. When the case is settled, Health Net may recover charges for services from the member's workers' compensation settlement. If the settlement agreement results in payment to the provider, the provider is responsible for refunding Health Net's payment.