CommercialPrior AuthMedium impact
21-212 Post-Stabilization Authorization for Emergency Out-of-Network (OON) Hospital Services Suspended
Health Net·CA · Emergency Medicine·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has suspended post-stabilization authorization reviews for out-of-network emergency hospital services due to COVID-19. Participating Physician Groups (PPGs) must refer all OON hospital post-stabilization authorization requests back to Health Net instead of reviewing them internally.
Action Required
Immediately: PPGs must stop reviewing out-of-network hospital post-stabilization authorization requests internally. Refer all such authorization requests back to Health Net for adjudication. Update internal workflows to ensure staff know to redirect these requests rather than process them in-house.