Revised Prior Authorization Requirements for OR Commercial Members

We regularly review the Prior Authorization List (PAL) to ensure we deliver the right balance of value and stability to our members. As a valued employer group with Health Net, we want you to be aware of PAL changes that may affect your employees’ health care coverage.

 

We have revised our commercial (EPO, POS, CommunityCare, and PPO) PAL requirements, effective January 1, 2017.

 

Significant changes to the list are:

 

New outpatient items requiring prior authorization

  • Balloon sinuplasty
  • Capsule endoscopy
  • Select outpatient pharmaceuticals: Cinqair, Eylea, Macugen, Nucala, Probuphine, and Visudyne

 

Prior authorization no longer required

  • Makena

 

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, or call 1-888-802-7001 (TTY: 711).

 

Additional information

Oregon (EPO, POS, CommunityCare, and PPO) subscribers are being sent this information. If they have questions regarding the information, they should contact the Health Net Customer Contact Center online at www.healthnet.com or by telephone at 1-888-802-7001 (TTY: 711). Customer Contact Center hours are Monday through Friday, 7:30 a.m. to 5:00 p.m., except federal holidays.

 

 

 

 

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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Susan Peters