HealthNet

Discover how Health Net insurance covers mental health and substance use disorder treatment, including verification processes and finding providers that meet your specific needs.

Navigating mental health treatment while managing insurance concerns can feel overwhelming, especially when you or a loved one is experiencing a behavioral health crisis. Health Net, a trusted insurance provider, offers comprehensive coverage for mental health and substance use disorder treatment as part of its commitment to whole-person health care.


Mental health conditions affect millions of Americans each year, making access to appropriate care essential. If you're covered by Health Net insurance and seeking mental health or substance use disorder treatment, this guide will help you understand your benefits, navigate the approval process, and find the care you need.


What Makes Health Net's Mental Health Coverage Distinctive

Health Net's approach to mental health care is built on the principle that mental health is an essential component of overall wellness. The company's behavioral health services are designed to provide timely access to appropriate care across the full spectrum of mental health and substance use disorder needs.


Health Net uses nationally recognized guidelines to review treatment plans, ensuring that care is evidence-based and provided in the least restrictive setting possible. This commitment to quality care means you can receive treatment that's tailored to your specific needs while maximizing your insurance benefits.


Their clinical philosophy centers around providing prompt access to the right care, with a focus on supporting behavioral health providers in delivering optimal outcomes. Health Net collaborates with providers to identify effective treatment plans and follows fair, consistent review processes for authorizations. The company evaluates not only immediate treatment needs but also long-term outcomes when reviewing proposed care plans.


Mental Health Services Covered by Health Net

Health Net plans cover a wide range of medically necessary mental health and substance use disorder services, as required by the Mental Health Parity and Addiction Equity Act (MHPAEA). This federal law ensures that coverage for mental health and substance use disorder treatment is comparable to coverage for medical and surgical care.


Common Mental Health Services Covered

Health Net's behavioral health benefits generally include:


The specific services covered and your out-of-pocket costs will depend on your particular Health Net plan. Some plans may only cover in-network providers, while others offer out-of-network benefits, typically with higher cost-sharing responsibilities.


Health Net works with an extensive network of mental health providers including clinical social workers, psychologists, marriage and family therapists, psychiatrists, and counselors. This diverse network ensures that members can find appropriate care for various mental health conditions and substance use disorders.


How Insurance Verification Works with Health Net

Understanding your Health Net coverage before beginning mental health treatment can help you avoid unexpected costs and ensure you receive the maximum benefits available.


The verification process typically begins by contacting Health Net using the toll-free number on your ID card, or by calling the Behavioral Health Services line at (888) 426-0030. Representatives can provide information about:

  • Who is eligible for plan benefits

  • Which services require preauthorization

  • Coverage for in-network versus out-of-network providers

  • Your expected out-of-pocket costs

  • Any benefit exclusions or limitations


When verifying your coverage, it's important to ask specific questions about the type of treatment you're seeking. For example, if you're considering residential treatment for substance use disorder, ask about coverage for that specific level of care, as well as any requirements for step-down care following residential treatment.


You should also inquire about your financial responsibility, including any deductibles that need to be met before coverage begins, copayments or coinsurance for each service, and your annual out-of-pocket maximum.


Understanding Health Net's Authorization Requirements

Health Net doesn't require preauthorization for most outpatient mental health services, such as standard office visits with therapists, psychiatrists, or other behavioral health professionals. This allows for quick access to basic mental health care when needed.


  • Psychological and neuropsychological testing

  • Inpatient and residential treatment (except in emergencies)

  • Partial hospitalization and intensive outpatient programs

  • Outpatient electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS)

  • Applied Behavioral Analysis (ABA) and related treatment plans


For emergency inpatient treatment, you or a family member, your doctor, or the hospital must notify Health Net Behavioral Health within 24 hours of admission. This ensures your benefits are in place and allows Health Net to assign a case manager to support you during your treatment and recovery.


The preauthorization process involves Health Net reviewing the proposed treatment plan before you receive care. Their review is based on nationally recognized clinical guidelines from organizations such as the American Society of Addiction Medicine (ASAM) and the American Association of Community Psychiatrists' Level of Care Utilization System (LOCUS).


Common Coverage Limitations and Out-of-Pocket Costs

While Health Net provides substantial mental health coverage, understanding potential limitations and costs will help you better plan for treatment.


Common limitations may include:

  • Network restrictions: Some plans only cover in-network providers or charge higher cost-sharing for out-of-network care

  • Medical necessity requirements: Services must be deemed medically necessary based on nationally recognized guidelines

  • Authorization requirements: Some services require preauthorization and ongoing concurrent review

  • Benefit-specific limitations: Certain treatments may have visit limits or other restrictions


Your out-of-pocket costs will depend on your specific Health Net plan and may include deductibles, copayments, and coinsurance. For example, with some Health Net HMO plans, members may have a daily copayment for inpatient substance use disorder treatment for up to five days, while outpatient treatment may require a fixed copayment per visit.


Under Health Net's model, ongoing concurrent review takes place throughout your treatment. This means a care manager will regularly review your progress to ensure you're receiving care in the most appropriate and cost-effective setting. As your clinical needs change, your level of care may be adjusted.


Navigating Health Net's Approval Process

Health Net uses several review methods to ensure that mental health and substance use disorder treatment is medically necessary and provided in the most appropriate setting.


The approval process begins with pre-service review for services requiring preauthorization. During this process, Health Net evaluates whether the proposed level of care is appropriate based on your symptoms, whether the treatment plan is based on clinical evidence with a reasonable probability of positive outcomes, and whether care is prescribed for the least restrictive setting possible.


Once treatment begins, concurrent review monitors your progress to ensure ongoing medical necessity. For treatments that couldn't undergo pre-service review (such as emergency services), post-service review may occur to determine medical necessity after treatment has been provided.


If Health Net believes a requested service isn't medically necessary or that treatment should be reconsidered, they'll work with your provider to identify alternatives. If services cannot be approved, Health Net will send you a letter explaining the reason and recommending alternatives. As a Health Net member, you always have the right to appeal modification and denial decisions.


Recent Developments in Health Net Mental Health Coverage

Health Net continues to enhance its mental health coverage in response to growing needs and regulatory changes. Recent developments include expanded access to telehealth services for mental health care, making it easier to connect with providers remotely.


Additionally, under new federal rules that strengthen access to mental health and substance use disorder benefits, Health Net and other insurers must ensure that mental health and substance use disorder benefits are comparable to medical and surgical benefits, with particular emphasis on provider network adequacy. These changes, which will be fully implemented by 2026, aim to reduce barriers to accessing mental health services.


The new rules specifically require Health Net and other insurers to evaluate the impact of their nonquantitative treatment limitations (like prior authorization requirements) on access to mental health and substance use disorder care compared to medical/surgical benefits. Insurers must collect and evaluate data related to these limitations and make changes if the data shows insufficient access to care.


Determining if Your Specific Health Net Plan Covers Needed Treatment

Each Health Net plan has different coverage levels and requirements for mental health treatment. Understanding your specific plan is essential to maximizing your benefits.


To verify your coverage:

  • Review your plan documents (Evidence of Coverage in California)

  • Log in to your Health Net member account to view personalized plan information

  • Call Health Net's Behavioral Health Services for the most accurate information

  • If applicable, check with your employer's benefits department for any additional coverage details


When speaking with representatives, ask about coverage for the specific services you're considering, your cost-sharing responsibilities, which providers are in your network, and the authorization process for services you may need.


Finding the Right Mental Health Treatment Facility

Choosing the right treatment facility is a crucial step in your recovery journey. When evaluating facilities that accept Health Net insurance, consider the level of care you need (outpatient, intensive outpatient, partial hospitalization, or inpatient), the facility's experience treating your specific condition, location and accessibility, treatment approaches and philosophy, whether the facility is in-network with Health Net, and the facility's process for insurance verification and authorization.


Before committing to a treatment program, verify coverage details and understand your out-of-pocket costs by calling the number on your Health Net ID card. Ask the facility about their experience working with Health Net and whether they'll help you navigate the authorization process.


Taking the Next Step Toward Mental Health Care

Seeking help for mental health or substance use disorders is a courageous step toward healing and recovery. With Health Net insurance, you have access to a wide range of treatment options and providers dedicated to supporting your journey to better mental health.


Remember that navigating insurance can be challenging, but you don't have to do it alone. Health Net offers resources to help you understand your coverage and find appropriate care. By using the information in this guide and reaching out for assistance when needed, you can make informed decisions about your mental health treatment.


Ready to find mental health or substance use disorder treatment covered by Health Net? Browse our treatment directory to find facilities in your area that accept Health Net insurance and offer the specialized care you need.


References

[1] "Behavioral Health | Health Net" https://www.healthnet.com/content/healthnet/en_us/members/behavioral-health.html

[2] "Health Net of California Insurance Coverage for Drug and Alcohol Rehab" https://americanaddictioncenters.org/insurance-coverage/health-net/california

[3] "Behavioral Health | UC" https://uc.healthnetcalifornia.com/members/behavioral-health.html

[4] "Departments of Labor, Health and Human Services, Treasury Issue Final Rules Strengthening Access to Mental Health, Substance Use Disorder Benefits | CMS" https://www.cms.gov/newsroom/press-releases/departments-labor-health-and-human-services-treasury-issue-final-rules-strengthening-access-mental