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How to Access Covered Care

Choose your doctor and change anytime.

Getting in-depth information on how your plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of great providers or stay with your current provider. And, remember, you can change at any time. Your plan provides you with that flexibility.

Here’s an overview of getting care with Choice Products. In the Preferred Provider Organization (PPO) plan, there are two options to choose from: In-Network Providers and Out-of-Network Providers.

For members who have a POS, Out-of-Area PPO, or PPO plan – For Information about Kaiser Permanente Insurance Company’s (KPIC’s) Network Adequacy Policy, please review our Frequently Asked Questions Document

In-Network Providers
Out-of-Network Providers

You have several network options for choosing care with in-network providers.

Provider Directory Options by Location:

In Colorado: Find Kaiser Permanente Providers and statewide network of contracted providers.

In Other Kaiser Permanente States: The Choice PPO’s First Health Network provides access to care in the Kaiser Permanente states of CA, , GA, HI, MD, OR, VA, WA, and DC.

In Non-Kaiser Permanente States: The Cigna Healthcare^SMPPO Network* only provides access to care in non-Kaiser Permanente states.

*The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Healthcare Intellectual Property, Inc.

To find an In-Network Provider or confirm if your current provider is In-Network, you can search for Providers by location (Kaiser Permanente and non-Kaiser Permanente states) or call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday 8 a.m.-6 p.m., Mountain time.

Many ways to access care through In-Network Providers.

In-Network Providers include Kaiser Permanente providers and a statewide network of contracted providers, First Health providers, and Cigna Healthcare PPO Network providers based on service location.
No referral is needed for office visits to In-Network Provider physicians or specialists. However, your In-Network Provider will need to obtain pre-certification for some services and procedures. Your In-Network Provider must call 1-855-364-3184 (TTY 711) for pre-certification.
It is always a good idea to call the provider’s office to confirm that they’re an In-Network Provider.

Can I nominate a physician to become an In-Network Provider?

Yes. If you were seeing a doctor who is not contracted with the First Health Network in other Kaiser Permanente states, or with the Cigna PPO Network outside of Kaiser Permanente states, you can nominate the doctor to join the network. Please keep in mind your provider may choose not to be contracted.
To nominate a provider, call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.
Nominations can take up to 60–120 days from receipt of the provider’s complete application. Whether a physician or practitioner is accepted depends on a number of considerations including the provider’s interest in joining, so a nomination doesn’t guarantee acceptance.

Helpful Tips

When making an appointment. If you are not seeing a Kaiser Permanente provider, make sure the provider is an In-Network Provider that is accepting new patients.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card. Make sure the provider only refers you to laboratory, radiology, and other covered services to In-Network providers and facilities that are also In-Network providers.
After your visit. Your In-Network Provider office will take care of claim submissions for you.

Out-of-Network Providers

Call any licensed provider’s office directly.

Your Out-of-Network Provider benefits cover care you receive from any licensed provider (not including In-Network Providers).
You can call the provider’s office directly to make an appointment.
You don’t need a referral for Out-of-Network Providers or specialists. However, you will need pre-certification for some services and procedures. You must call 1-855-364-3184 (TTY 711) for pre-certification.
Your doctor may require you to pay the full cost of the visit. And you will need to submit claim forms and itemized bills for reimbursement.
You’ll have to pay applicable cost share and meet a deductible. You’ll also be responsible for any difference between what your provider charges for service and the payment Kaiser Permanente Insurance Company provides.

Helpful Tips

When making an appointment. Make sure the provider understands that your plan allows you to see any licensed provider.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card.
After your visit. When you receive services from an Out-of-Network Provider, you will submit a claim and will be responsible for paying the difference.

You’ll generally pay the highest out-of-pocket costs when you receive services from an Out-of-Network Provider or facility.

It’s important to keep in mind:

Your cost-shares will vary depending on whether you choose in-network or out-of-network care.
The amount you pay for a particular service will depend on the provider you choose and—in some cases—where you choose to receive care.

To find out more:

See your Choice PPO New Member Guidebook (Coming Soon) for details about accessing covered care.
Refer to your Certificate of Insurance (COI).
Contact the human resources/benefits officer where you work, if your employer provides your coverage.
Call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m.–6 p.m., Mountain time, or refer to your ID card.

Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. underwrites the Choice PPO Plan. Kaiser Permanente Insurance Company is contracted with First Health, First Health is a brand name of First Health Group Corp. The list of In-Network First Health providers is subject to change without notice. Some services require pre-certification.

KPIC has also contracted with the Cigna Healthcare^SM PPO Network outside of Kaiser Permanente states for health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Healthcare Intellectual Property, Inc.