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.
Some services are covered only if your doctor or other plan provider gets "prior authorization" (approval in advance) from Health Net. Covered services that need prior authorization are marked in the Benefits Chart in your Evidence of Coverage (EOC). EOCs vary by plan; to view them, please visit our Shop portal to find a plan in your area.
Some drugs require prior authorization. This means that you must receive approval from Health Net before the drug will be covered. The prior authorization process ensures you are receiving the correct drug combined with the best value for your medical condition.
To obtain prior authorization, you, your prescriber, or your appointed representative can email, mail or fax a request to us. Our contact information is listed below. In your email, be sure to include your name, Health Net member ID number and telephone number, as well as the details of your request. The Member Medicare Part D Coverage Determination Request form can be completed and attached to your email or used as a guide of information to include.
Upon receipt by Health Net, the request will be evaluated to determine if it meets standard 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.
We must make our decision regarding an exception request (including a formulary exception, an exception from utilization management rules - such as dosage or quantity limits or step therapy requirements - or a tiering exception), and respond no later than 72 hours after we have received your prescriber's supporting statement. The prescriber's supporting statement should explain why the requested drug is medically necessary. In addition, you, your prescriber, or your authorized representative can ask us to make a "fast" decision (rather than a "standard" decision) about Part D prescription drug coverage that you have not already received. If a fast decision is granted, we must make our decision and respond within 24 hours. For a fast decision, you may contact us by faxÃƒ‚Ã‚Â or by telephone at the number below. We will make our decision and respond to all requests as expeditiously as your health condition requires.
Consult your Evidence of Coverage for specific information about drug coverage and limitations. 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. If you have questions about this process, please contact Customer Service at the numbers listed below.
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 email@example.com in the To: field. Please attach any supporting or relevant documents to your secure email message.
13221 SW 68th Parkway, Suite 200
Tigard, OR 97223
Members: Contact Customer Service
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.
Link to the Centers for Medicare and Medicaid Services (CMS) Request for Medicare Prescription Drug Determination Form (for use by enrollees).
Information last updated 09/27/2012