How to Access Covered Care
Choose your doctor or change your doctor. Anytime.
With the Kaiser Permanente Added Choice® plan, you have a broad selection of providers to choose from.
Added Choice® lets you choose to receive covered services from KP Select Providers, PPO Providers, or Non-Participating Providers. The services we cover, and what you pay, will differ depending on the provider you choose.
To know if your plan allows for cross-accumulation between these providers for your deductible and out-of-pocket-maximum, see your Evidence of Coverage. Get more information on managing your deductible plan.
KP Select Providers
Kaiser Permanente Providers
Many ways to access care with KP Select Providers.
- Your care with KP Select Providers starts with your primary care physician who will help coordinate your care. You choose your own doctor, and you can change your doctor at any time.
- Choose a provider from Kaiser Permanente. These providers have the lowest out-of-pocket costs.
- You can manage your care at kp.org. Log in anytime from anywhere to make routine appointments, refill most prescriptions, see most lab results, and much more.
- Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit.
PPO Providers
First Choice Health, First Health Network, and Cigna HealthcareSM PPO Network1
Choose a PPO Provider from First Choice Health, First Health Network or Cigna Healthcare PPO Network. This provider option is for members that wish to keep their current PPO Provider or who live outside our service area.
To find a PPO Provider or confirm if your current provider is part of the First Choice Health, First Health Network, or Cigna Healthcare PPO Network, please visit the link below or contact Customer Service at 1-866-616-0047.
First Choice Health
(Members receiving care in Oregon and Washington.)
First Health Network
(Members receiving care in California, Colorado, Georgia, Hawaii, Maryland, Virginia, and DC.)
Cigna HealthcareSM PPO Network
(Members receiving care in all other states.)
- Most First Choice Health, First Health or Cigna Healthcare PPO 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. Prior authorization may be needed for some services and procedures.
- Your First Choice Health and First Health Network Providers must call 1-855-281-1840 (TTY 711) and Cigna Healthcare PPO Network providers must call 1-888-831-0761. Failure to get prior authorization may result in greater out-of-pocket cost to you.
- It is always a good idea to call the provider’s office to confirm they are a Participating Provider and are accepting new patients.
Can I nominate a physician to become a PPO provider?
- Yes. If you want to see a doctor who is not a member of the First Choice Health, First Health Network or Cigna Healthcare PPO Network, you can nominate that doctor to become a participating PPO Provider. Please keep in mind your provider may choose not to participate.
- To nominate a provider, contact Customer Service 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 checking in for your visit. Bring your Added Choice® ID card with you or access your digital ID card via kp.org. If your PPO Provider has any questions, have them call 1-866-616-0047 (TTY 711).
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 Customer Service to learn more.
1. 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 HealthcareSM 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
Non-participating Providers
Call any licensed provider’s office directly.
- Your Non-Participating Provider benefits cover care you receive from any other licensed provider (who is not a KP Select or PPO Network Provider).
- 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 or your provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization may result in greater cost share to you.
- 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 Added Choice ID card with you. If your provider has any questions, have them call the Added Choice® Contact Center phone number on the back of your ID card.
After your visit. . Some Non-Participating Providers will require you to submit the claim. You will be responsible for paying the cost difference in addition to your copay and coinsurance.
You’ll pay the most out-of-pocket costs when you receive services from a Non-Participating Provider or facility.
It’s important to keep in mind:
- The services we cover, and what you pay, will differ depending on the provider you choose.
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 Customer Service at 1-866-616-0047 (TTY 711).
Some services require prior authorization. For more information, see your Evidence of Coverage (EOC).