Whos responsible for getting prior authorization?
When you see an in-network provider, he takes care of contacting Health Net for prior authorization, which should take no longer than 48 hours, excluding weekends. When you see an out-of-network provider, you need prior authorization for all inpatient hospitalizations and certain out-of-network elective surgical, diagnostic, and therapeutic procedures. If your provider is out-of-network, ask if he’ll obtain prior authorization for you. If he won’t make the arrangements, call the toll-free prior authorization phone number at (888) 747-8080. Have your doctor’s name and phone number and the procedure code on hand. The call must be made at least seven business days before the procedure and within two days of an emergency admission. Failure to obtain prior authorization for inpatient hospital stays and elective procedures will reduce your out-of-network benefits for medically necessary procedures by 50 percent or $500, whichever is less.
