Claims

In-Network Providers

When you receive care from a network provider, you usually will not have to file a claim. Your provider generally completes and submits the claim on your behalf.

Out-of-Network Providers

When you receive care from an out-of-network provider, you may have to submit a claim for reimbursement. You may be required to pay the full amount you are billed when you receive care. If so, you’ll need to submit a claim form with an itemized bill for reimbursement.

Filing a Claim

You may request us to pay you back by sending us a written request. If you send a request in writing, send your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.
You can file a claim to request payment by:

• Completing our electronic form at kp.org and uploading supporting documentation
• Either download a copy of the form from kp.org or call Member Services and ask them to send you the form. Please mail the completed form to our Claims Department address listed below.
• If you are unable to get the form, you can file your request for payment by sending us the following information to our Claims Department address listed below:
  • Your name (member/patient name) and medical/health record number.
  • The date you received the services.
  • Where you received the services.
  • Who provided the services.
  • Why you think we should pay for the services.
  • Your signature and date signed. (If you want someone other than yourself to make the request, we will also need a completed “Appointment of Representative” form, which is available at kp.org.)
  • A copy of the bill, your medical record(s) for these services, and your receipt if you paid for these services.

You must submit your claim to us within 12 months (for Part C medical claims) and within 36 months (for Part D drug claims) of the date you received the service, item, or drug.
Mail your request for payment together with any bills or paid receipts to us at this address:

Kaiser Permanente Claims
P.O. Box 373150
Denver, CO 80237-9998