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These authorization requirements pertain only to local in-network providers.

PLEASE NOTE – All out of area (outside of Humboldt and Del Norte Counties) and/or out of network services require prior authorization.

Providers must confirm with the health plan that the members health plan coverage is still in effect and services being provided is a covered benefit within 5 days before the actual date of service. The health plan reserves the right to revoke this authorization prior to services being rendered based on cancellation of the members eligibility.
Final determination of benefits will be made after review of the claim for and in light of medical necessity requirements and other limitations or exclusions.