MedicaidAdministrativeMedium impact
23-387 Arrange for Covered Services When Services Are Not Available from Contracted Providers
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net must now actively arrange appointments with out-of-network providers when in-network services are unavailable within required timeframes. This shifts responsibility from simply providing provider lists to actually contacting and scheduling appointments for members with non-contracted providers.
Action Required
Immediately: Billing and patient access teams must understand that Health Net (not the practice) is now responsible for arranging out-of-network appointments when services are unavailable in-network. When members cannot get timely appointments, direct them to contact Health Net Provider Services to arrange out-of-network care rather than providing them with lists of providers.