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The directory lists health care providers, facilities, and support providers that you may see as a Health Net Cal MediConnect member. We also list the pharmacies that you may use to get your prescription drugs.

Some network providers or pharmacies may have been added or removed from our network or no longer be accepting new members. Contact us to get the most up-to-date list of Health Net Cal MediConnect’s network providers and pharmacies in your area.

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Provider and Pharmacy Network Information

You must get all your covered services from network providers within your PCP’s medical group. Exceptions are when you need urgent or emergency care, out-of-area dialysis services, or Health Net allows you to use an out-of-network provider.

You must also use network pharmacies to get prescription drugs, except in emergency or urgent care situations.

For some services, you may need a referral from your PCP.

Contact us to ask if we will pay for any medical service or care you want or need before you get the service or care.

Provider Frequently Asked Questions

Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.

A Primary Care Provider (PCP) is a doctor who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. Your PCP will also give you a referral if you need to see a specialist or other provider.

You can get services from any provider who is in our network and accepting new members.

You may also be able to choose a specialist who acts as your PCP. The specialist must be willing and able to provide the care you need. Contact us if you need to ask for a specialist to be your PCP.

Our plan's PCPs work with medical groups. A Medical Group is a group of PCPs, specialists, and other health care providers that work together. We contract with Medical Groups to work with our plan.

When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are also affiliated with his or her medical group.

  • It is important to confirm if a specialist or hospital you want to use works with your PCP's medical group. Contact us to see if the PCP you want makes referrals to that specialist or uses that hospital.

To choose a PCP, choose a provider:

  • that you use now, or
  • who has been recommended by someone you trust, or
  • whose offices are easy for you to get to.

Contact us if you want help in choosing a PCP.

You may change providers within the network at any time. You do not have to keep going to the same network provider you have been going to.

Remember, our plan's PCPs work with medical groups. If you change your PCP, you may also be changing medical groups. When you ask for the change, tell Member Services if you are seeing a specialist or receiving other covered services that need PCP approval. Member Services will help make sure you can keep your specialist and other services when you change your PCP.

Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialist. Here are a few examples:

  • Oncologists care for patients with cancer.
  • Cardiologists care for patients with heart conditions.
  • Orthopedists care for patients with certain bone, joint, or muscle conditions.

You may need a referral to see a specialist or someone that is not your PCP. A referral means your network PCP must approve you seeing the other provider. Health Net Cal MediConnect may not cover a service if you don’t get a referral.

You do not need a referral from your network PCP for:

  • Emergency care.
  • Urgently needed care.
  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are outside the plan’s service area.
  • Services from a women’s health specialist.

Additionally, if you are eligible to get services from Indian health providers, you may see these providers without a referral. We must pay the Indian health provider for those services, even if they are out of our plan's network.

More information on referrals is available in Chapter 3 of the Member Handbook.

As a Health Net Cal MediConnect member, you may be able to get long-term services and supports (LTSS). Long-term services and supports are help for people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.

These services include:

  • Community-Based Adult Services (CBAS) is a community-based day health program. CBAS provides services to older persons and adults with chronic medical, cognitive, or mental health conditions, and/or disabilities. They are also at risk of needing institutional care.
    • When you become a Cal MediConnect member, contact us to apply for CBAS.
  • The Multipurpose Senior Services Program (MSSP) provides services for people age 65 or older. With long-term custodial care in nursing facilities, the health plan makes sure that care is consistent and any transition is well-planned.

More information on referrals is available in Chapter 4 of the Member Handbook.

Contact us for more details on LTSS.

You may be able to keep seeing your doctor that is not in our network.

Have you seen a doctor or specialist once in the last 12 months? When you become a Cal MediConnect member, contact us to inform us that you want to keep seeing your doctor. We must contact your doctor and try to work with them to keep your care with that doctor.

Your doctor must agree to work with us. You may be able to see that doctor for up to 12 months. After that, if your doctor did not agree to join our network, we will work with you to find a network doctor.

There may be a few providers you will not be able to keep seeing. Contact us for more information.

Contact us right away if you have a scheduled treatment and just joined our Cal MediConnect Plan. We must work with you and your doctors to make sure your care is not disrupted.

Health Net Cal MediConnect works with all the providers in our network to meet the needs of people with disabilities. The list of network providers in our Directory includes information about the accommodations they provide. Contact us if you need to find a provider that offers the accommodations you need.

Our pharmacy directory provides a list of pharmacies in the Health Net Cal MediConnect pharmacy network. Network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

We also list pharmacies that are in our network but are outside the area in which you live. You do not need to keep going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network. Contact us for more information.

Health Net Cal MediConnect members must use network pharmacies to get prescription drugs.

  • You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out-of-pocket for the service. Read the Health Net Cal MediConnect Member Handbook for more information.
  • Some network pharmacies may not be listed in the directory.
    • Some network pharmacies may have been added or removed from our plan after the Directory was published.

Mail Order Program
We offer a mail order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.

If the mail order pharmacy gets a prescription directly from a prescriber, they will call you first to confirm you want the drug(s). Please make sure to let the pharmacy know the best way to contact you.

90-day Retail Pharmacy Programs
Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.

To get a complete description of your prescription coverage, please read the member handbook and Health Net Cal MediConnect's List of Covered Drugs.

Contact us for information.

Along with retail pharmacies, your plan’s network of pharmacies includes:

  • Mail order pharmacy
    You can get prescription drugs shipped to your home through our network mail order delivery program. Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time, or if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-855-464-3571 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.
  • Home infusion pharmacies
    Home infusion pharmacies are generally for patients receiving home infusion therapy and may not be available to all members. You can go to any home infusion pharmacy in our pharmacy network.
  • Long-term care (LTC) pharmacies
    Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Health Net Cal MediConnect through the facility’s pharmacy or another network pharmacy. Long-term care pharmacies are for people that live in a long-term care facility and may not be available to all members.
  • Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies
    Only Native Americans and Alaska Natives have access to Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Pharmacies through Health Net Cal MediConnect’s pharmacy network. Those other than Native Americans and Alaskan Natives may be able to go to these pharmacies under limited circumstances (e.g., emergencies).
  • Specialty pharmacies

    Contact us for information.

Our Provider and Pharmacy Directories are available for download in the Resources / Materials section of this website.

Information last updated: 07/11/2018