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.
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 doctor, or your appointed representative can ask for a fast decision only if you or your doctor 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 (see below). You can also mail or fax a written request to Health Net at the address below. Be sure to ask for a "fast," "expedited," or "24-hour" review. Although there are no required forms, the Medicare Part D Coverage Determination Request Form (for physicians) and the Request for Medicare Prescription Drug Coverage Determination Form (for members) can be accessed using the links on the preceding page.
To ask for a standard decision, you, your doctor, or your appointed representative can mail or fax a written request to the address below. There are no required forms. If we deny your request (this is sometimes called an "adverse coverage determination"), you can "appeal" our decision by going on to Appeal Level 1.
Consult your Evidence of Coverage for specific coverages and limitations. The fact that a drug is listed on the Drug List does not guarantee that your physician will prescribe it for you for a particular medical condition. If you have questions about this procedure, please contact Customer Service at the number listed below.
HNPS Prior Auth Department
10540 White Rock Road, Suite 280
Rancho Cordova, CA 95670
Members should call:
|Health Net Orange (PDP):||800-806-8811, TTY/TDD 800-929-9955
(8 am - 8 pm, 7 days a week)
Physicians should call: 800-867-6564
Information last updated 02/08/2011