Revised Prior Authorization Requirements for Health Net Health Plan of Oregon, Inc. Commercial Members
At Health Net Health Plan of Oregon, Inc. (Health Net), we regularly review the Prior Authorization List (PAL). As a Health Net broker, we want you to be aware of PAL changes that may affect your clients’ health care coverage.
Effective January 1, 2016, we have revised our commercial [EPO, POS, CommunityCare, and PPO] PAL requirements. Significant changes to the list are indicated below. A complete copy of the new January 1, 2016, PAL requirements is attached for your reference.
New outpatient procedures, services or equipment requiring prior authorization:
- Select outpatient medical benefit pharmaceuticals, including Cosentyx, Lemtrada, Mircera, Radiesse, Sculptra
- Total ankle replacements
Oregon [EPO, POS, CommunityCare, and PPO] subscribers will be sent this information by October 31, 2015. If they have questions regarding the information, they should contact the Health Net Customer Contact Center either online at www.healthnet.com or by telephone at 1-888-802-7001. Customer Contact Center hours are Monday through Friday, 7:30 a.m. to 5:00 p.m., except holidays.