Prior Authorization Process
Please note: This general information may not apply to all Health Net plan types. To learn more about your plan benefits, please review your plan documents.
A specialist is a doctor you see for certain types of health conditions. There are many types of specialists, including cardiologists, oncologists and orthopedic surgeons.
Some Health Net plans allow you to access specialists directly, while others may require your primary care physician (PCP) to give you a specialist referral. Check your plan document for details on how to get care from a specialist on your specific plan.
Typically, a referral is a request from your PCP for you to see a specialist. Depending on your plan, you may need a referral before you can see a specialist. Health Net may need to approve your referral before your specialist visit. This is called an "authorization."
Examples of referrals can be to an orthopedic surgeon for a back injury or to a cardiologist for a heart condition.
You may need to get approval from Health Net before you can get certain heath care services. This process is called getting "prior authorization." You can learn more about prior authorization in your plan coverage documents.