Our PPO Plus® plans provide members living outside the Kaiser Permanente NW service area with access to the PPO Provider Network and Non-participating Providers.
The services we cover, and what you pay, will differ depending on the provider you choose.
This network is served by First Choice Health, First Health Network, and Kaiser Permanente providers and facilities. Your copay, coinsurance, and deductible are at the same level, regardless of which PPO provider or PPO facility you choose. This network provides care at the lowest out-of-pocket costs.
To find a PPO Provider or confirm if your current provider is part of the PPO Provider Network, please visit our customized locators.
First Choice Health Network
(Members receive care in OR, WA, ID, MT, WY, ND, SD, and AK.)
First Health Network
(Members receive care in all states EXCEPT OR, WA, ID, MT, WY, ND, SD, and AK.)
If you have any questions or need help with any of the PPO providers, you may contact their customer support at:
First Choice Health
1-800-467-5281
First Health Network
1-800-226-5116
Kaiser Permanente
1-866-616-0047
Features and benefits of our plan:
For additional information on what is covered under the PPO Provider Network:
*Inpatient and certain outpatient services are subject to prior authorization. Your PPO Provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization will result in greater out-of-pocket cost to you.
This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.
For its PPO Provider Network, Kaiser Permanente has contracted with First Choice Health or First Health Network. The list of participating First Choice Health or First Health Network providers is subject to change without notice.
Choose a non-participating provider nationwide. Non-participating providers include any licensed providers who are not PPO providers. Utilizing these providers will result in higher out-of-pocket costs.
Features and benefits of receiving covered care from Non-participating Providers:
For additional information on what is covered with Non-participating Providers:
Call Customer Service at 1-866-616-0047 (TTY 711).
*Inpatient and certain outpatient services are subject to prior authorization. Your Non-participating Provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization will result in greater cost to you.
This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.
If you use a Non-participating Provider, it is important that you understand balance billing. Balance billing can mean significant out-of-pocket costs for you.
What is balance billing?
Balance billing is the difference between what a Non-participating Provider charges for a service and what Medicare will reimburse for that service. What Medicare will reimburse for the service is called an “allowed amount.”
For example, if a Non-participating Provider charges $100 and the allowed amount is $70, the provider can balance-bill you directly for the difference — in this case, $30. You will be responsible for paying all amounts above the allowed amount.
This is one reason why it’s generally less expensive to use PPO Providers (a Kaiser Permanente provider or a provider in the PPO Provider Network). PPO Providers cannot bill you above the allowed amount.
Other things to know about balance billing:
Call Customer Service at 1-866-616-0047 (TTY 711) for more information.