Reminder: Revised Prior Authorization Requirements for AZ Commercial Members

Health Net of Arizona, Inc. (HMO) and Health Net Life Insurance Company (PPO, POS)(together “Health Net”)

 

As a reminder of the communication that was sent out several weeks ago, we want you to be aware of Prior Authorization List (PAL) changes that may affect your clients’ health care coverage. We regularly review the Prior Authorization List (PAL) to ensure we deliver the right balance of value and stability to our members.

 

We have revised our commercial PAL requirements, effective January 1, 2017. Significant changes are listed below.

 

New outpatient items requiring prior authorization

  • Balloon sinuplasty
  • Capsule endoscopy
  • Penile implant

 

New medical benefit pharmaceuticals requiring prior authorization

  • Cinqair, Eylea, Macugen, Nucala, Probuphine, and Visudyne

 

Prior authorization no longer required

  • Makena

 

Accessing prior authorization requirements

A complete copy of the new January 1, 2017, PAL requirements is linked here for your reference.

 

For a copy of the current PAL requirements, members can:

  • Log in to our website at www.healthnet.com. Then, under My Coverage, click Preauthorizations > Prior Authorization List.
  • Call Health Net at the numbers below.

 

 

Need more information?

If members have questions they can contact the Health Net Customer Contact Center online at www.healthnet.com or by telephone:

 

  • Call Health Net at 1-800-289-2818 (TTY: 711)
  • Call 1-888-926-1870 (TTY: 711) if they are enrolled in a Health Net plan through the Health Insurance Marketplace (HIM).

 

Our Customer Contact Center is available Monday through Friday, 7:30 a.m. to 5:00 p.m., except federal holidays.

 

 

Health Net of Arizona, Inc. underwrites benefits for HMO plans. Health Net Life Insurance Company underwrites benefits for PPO and indemnity plans and for life insurance coverage. Health Net of Arizona, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved.

 

 

 

 

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Susan Peters