Choice Products Northwest

For Members

How to Access Covered Care

With the Kaiser Permanente PPO Plus® plan, you’ll have the freedom to choose any doctor or hospital you want, anywhere in the country.

With PPO Plus®, there are 2 tiers, or levels of benefit, to choose from: preferred provider organization (PPO) network, or non-participating providers.

Preferred Provider Organization (PPO) Network Tier

We provide many ways to access care through participating providers.

To find a participating provider or confirm if your current provider is part of the network, please visit our customized network locators.

First Choice Health Network
(Members receiving care in OR, WA, ID, MT, WY, ND, SD, and AK.)

First Health Network
(Members receiving care in all states EXCEPT OR, WA, ID, MT, WY, ND, SD, and AK.)

Kaiser Permanente

If you have any questions or need help with any of the PPO providers, you may contact their customer support at:

First Choice Health Network
1-800-467-5281

First Health Network
1-888-685-7774

Kaiser Permanente
1-866-616-0047 (TTY 711)

  • Most First Choice Health or First Health Network providers do not require a referral for specialty care. However, this is determined by the specialty provider so please inquire with them when scheduling your appointment. You will need prior authorization for some services and procedures. Your 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.
  • It is always a good idea to call the provider’s office to confirm they are a participating provider.

Can I nominate a physician to become a PPO provider?

  • Yes. If you were seeing a doctor who is not a member of the First Choice Health Network or First Health Network before you became a member, you can nominate that doctor to join our network. Please keep in mind your provider may choose not to join the network.
  • To nominate a provider, contact the PPO Plus Contact Center at 1-866-616-0047 (TTY 711).
  • Review can take up to 6 months. 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. Make sure the provider is a participating provider (that is, part of the First Choice Health Network or First Health Network or Kaiser Permanente) and is accepting new patients.
  • When checking in for your visit. Bring your PPO Plus ID card with you. If your provider has any questions, have them call the PPO Plus Contact Center phone number on the back of your ID card. All referrals should be to participating providers.You can request your provider send lab, X-rays, and special procedure (MRIs, CT scans, PET scans, nuclear medicine) orders to a Kaiser Permanente facility. Once complete, Kaiser Permanente can send the results to your participating provider. Contact an PPO Plus Navigator at 503-813-3981 for assistance or to learn more.

Kaiser Permanente providers

  • Choose a provider from Kaiser Permanente in Oregon and Washington (Clark and Cowlitz counties) or The Portland Clinic.* You can make an appointment online at kp.org or by calling 1-866-616-0047 (TTY 711).
  • You can manage care at kp.org.
  • Log in anytime from anywhere to make routine appointments and see most lab results, and much more.
  • Video or telephone visits with a doctor are available at no extra cost to most Added Choice members. Members with a health savings account (HSA)–qualified high-deductible health plan (HDHP) will pay a fee for scheduled phone and video visits subject to your plan’s deductible.

* A referral may be required for participating providers.

Non-participating provider tier

Any other licensed provider or physician. Call any licensed provider’s office directly.

  • Your non-participating provider tier benefits cover care you receive from any licensed provider (outside the PPO provider tier).
  • You can call the provider’s office directly to make an appointment.
  • Most providers do not require a referral for specialty care. However, this is determined by the specialty provider so please inquire with them when scheduling your appointment. You will need prior authorization for some services and procedures. You must call 1-855-281-1840 (TTY 711) for prior authorization.
  • 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.

When using a non-participating provider or facility, you will be responsible for the amount you are billed above the maximum allowable charge set out in your Evidence of Coverage (EOC) — this is referred to as balance billing. These charges billed directly by your provider do not apply to your deductible or out-of-pocket maximum.

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 PPO Plus ID card with you. If your provider has any questions, have them call the PPO Plus Contact Center phone number on the back of your ID card.

After your visit. Some out-of-network providers will require you to submit the claim. You will be responsible for paying the cost difference.

You’ll pay the most out-of-pocket costs when you receive services from a non-participating provider or facility.

For more information, see your Evidence of Coverage (EOC). For its PPO provider network, Kaiser Permanente has contracted with First Choice Health Network or First Health Network. The list of participating First Choice Health Network or First Health Network providers is subject to change without notice. Some services require prior authorization.

It’s important to keep in mind:

  • Your share of the cost will vary in each provider tier.
  • The amount you pay for a service will depend on the provider tier you choose and — in some cases — where you choose to receive care.

To find out more:

  • Refer to your Evidence of Coverage (EOC).
  • Contact the human resources/benefits representative where you work, if your employer provides your coverage.
  • Call the PPO Plus Contact Center at 1-866-616-0047 (TTY 711).

Some services require prior authorization. For more information, see your Evidence of Coverage (EOC).