Centene and health net news

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Our goal is to ensure this transition is seamless and effective for both providers and members. In addition, we are committed to serving commercial members through employer-sponsored benefits and state health insurance exchanges. By offering a range of healthcare solutions, we make it easy for your patients to get covered. In addition to expanding and improving our product options, we are focusing on the experience of our providers.

We are committed to serving and supporting you, so you can continue delivering quality care to our members. As always, your participation in our network is appreciated. No Medical Advice. The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.

No Authorization or Guarantee of Coverage. The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply. Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions.

Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations.

The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract also known as the benefit contract, coverage document, or evidence of coverage conflicts with the Policies, the Member's contract shall govern.

The Policies do not replace or amend the Member contract. Policy Limitation: Legal and Regulatory Mandates and Requirements The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements.

If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.

To improve function; or 2. To create a normal appearance, to the extent possible. Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance. Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.

Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. Policy Limitations: Medicare and Medicaid Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members.

The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation. To provide you with the most accurate plans and information in your area, we need to know your location. Log In Register Contact Us. Shoppers Members Employers Brokers.

If you wish to change your location, please click this link. After you log in, this setting will be updated to match the location associated with your account.

There are many current positive alignments with Centene and Health Net, including: Large memberships. Local service model. Working with influential business partners such as brokers and consultants. High levels of service. Custom benefit plans and tailored networks. And these will flourish with our merger!

This awareness creates tremendous synergy and selling opportunities for Health Net and our business partners now that we're operating under Centene: Local leadership: Our regional presidents reside in California, Arizona and Oregon.

Our regional sales leaders and teams remain servicing their local business partners and accounts. Various operational functions will be located in each of our local markets. Our local executive leadership teams are responsible for driving growth and making sure our members receive a high standard of care. With the purchase of Health Net, Centene can now amplify a local business approach to more markets in government programs and commercial lines, including: Increasing our number of employer groups in every region and acquiring more members.

Launching new products focused on competitive pricing. Commercial contracting Medicare contracting Centene Corporation Business Ethics and Conduct Policy pdf ProviderSearch Find the right doctor, hospital, urgent care, dentist, chiropractor, and more. We are here to answer your questions. Contact us. Log In: Members. Log In: Brokers. Log In: Employers.

Log In: Providers. Disclaimer You are now leaving Health Net's website for Medicare. To proceed to Medicare. To stay on the Health Net website, click 'Cancel'. Cancel Continue. Important Notice General Purpose Health Net's National Medical Policies the "Policies" are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary.

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