The subscriber number can be found on your Health Net Insurance card. Please enter the complete ID, including all letters and numbers. All letters must be typed as capital letters.
If your prescriber or pharmacist tells you that a prescription drug is not covered, you may contact us and request a coverage determination. Upon receipt by Health Net, the request will be evaluated to determine if it meets approval criteria. Our response to your request will explain if the drug you are requesting will be covered under your Medicare Part D benefit. If we deny your request (this is sometimes called an adverse coverage determination), you can appeal our decision. Information on how to file an appeal is included with the denial notification.
You can request an exception to our coverage rules. There are several types of exceptions you can request.
Generally, Health Net will only approve your request for an exception if preferred alternative drugs or utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.
A decision about whether we will cover a Part D prescription drug can be a "standard" coverage determination that is made within the standard timeframe (typically within 72 hours) or it can be a "fast" coverage determination that is made more quickly (typically within 24 hours). A fast decision is sometimes called an expedited coverage determination.
You, your prescriber, or your appointed representative can ask for a fast decision only if you or your prescriber believe that waiting for a standard decision could seriously harm your health or your ability to function. (Fast decisions apply only to requests for Part D drugs that you have not received yet. You cannot get a fast decision if you are requesting payment for a Part D drug that you already received.). To request a fast decision, contact Customer Service at the phone number listed below. You can also mail or fax a written request to Health Net at the address below. Be sure to ask for a fast or expedited review.
To ask for a standard decision, you, your prescriber, or your appointed representative can email, mail or fax a request to us. Our contact information is listed below. If we deny your request (this is sometimes called an adverse coverage determination), you can appeal our decision. Information on how to file an appeal is included with the denial notification.
For more information about coverage determinations, exceptions and prior authorization, you may refer to the sections of the Evidence of Coverage (EOC) for your plan listed below, or you may call Customer Service at the number listed below. The fact that a drug is listed on the formulary does not guarantee that it will be prescribed for you for a particular medical condition.
|Plan Name||Coverage Determinations EOC Section|
|Health Net Orange Option 1 (PDP), Health Net Value Orange Option 2 (PDP), Health Net Orange Option 2 (PDP)||Chapter 7, section 4|
To protect your personal health information and privacy, please do not send emails to Health Net using your personal email account. Health Net has a Secure Messaging Center to make corresponding with us safe and efficient. To access Secure Messaging, you must be registered on www.healthnet.com.
Login to the Secure Messaging Center. Select Compose. You will be prompted to enter an email address in the To: field. Paste firstname.lastname@example.org in the To: field. Please attach any supporting or relevant documents to your secure email message.
HNPS Prior Auth Dept.
10540 White Rock Road, Suite 280
Rancho Cordova, CA 95670
Health Net Customer Service (8 am - 8 pm, 7 days a week):
Prescribers should call:
Calls received after hours will be handled by our automated phone system and a Health Net representative will call you back on the next business day.
Information last updated 08/20/2012