Revised Prior Authorization Requirements

For Oregon Members and Employees

 

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) to ensure our members receive safe and appropriate medical care. As a valued employer group with Health Net, we want you to be aware of PAL changes that may affect your employee’s health care coverage.

Effective January 1, 2014, we have revised our commercial [EPO, Point of Service (POS), CommunityCare and PPO] PAL requirements. Significant changes to the list are indicated below. For a complete copy of the PAL requirements, please log in to our website at www.healthnet.com, click on Preauthorizations under My Coverage > Prior Authorization List, or call 1-888-802-7001.


Changes to Commercial Prior Authorization Requirements for Health Net Health Plan of Oregon, Inc. Commercial EPO, Point of Service (POS), PPO, and CommunityCare

Prior authorization no longer required:

  • Ambulance – non-emergency air or ground transportation.
    To verify whether non-emergency ambulatory service is a covered benefit, members should contact the Health Net Customer Contact Center as listed under the Additional Information section below.

 

New procedures, services or equipment requiring prior authorization:

  • cochlear implants;
  • genetic testing;
  • outpatient pharmaceuticals: Ilaris®, Simponi® Aria™, Soliris®;
  • proton beam therapy;
  • sleep studies;
  • septoplasty; and
  • X-Stop.

 

Additional Information
Oregon EPO, POS, CommunityCare and PPO subscribers will be sent this information by mail on October 31, 2013. 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.

 

OR107058_EMPL (10/13) Health Net Health Plan of Oregon, Inc. is a subsidiary 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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Stacy Madden