Prior Authorization
To ensure that the medical service ordered is medically necessary, Prior Authorization may be required. This is known as Prior Authorization for services ordered by a PPO Provider, or Non-participating Provider.
What requires Prior Authorization?
- For PPO Providers and Non-participating Providers, some services, such as inpatient care (for example, hospital surgical procedures) and some outpatient procedures, require prior authorization to be covered.
- For care with Kaiser Permanente providers, your provider will arrange for prior authorization, if required, for certain services.
How do I receive Prior Authorization?
- To obtain Prior Authorization or for questions about medical necessity requirements, please call Kaiser Permanente at 1-855-281-1840 (TTY 711).
- First Choice Health and First Health Network Providers must call 1-855-281-1840 (TTY 711) and Cigna HealthcareSM PPO Network1 providers must call 1-888-831-0761 for prior authorization. Failure to get prior authorization may result in greater out-of-pocket cost to you.
- You or your Non-participating Provider may obtain Prior Authorization by calling 1-855-281-1840 (TTY 711). If you don’t obtain Prior Authorization for services with Non-participating Providers you may have to pay the entire expense.
- To learn more, review the Prior Authorization section in your Evidence of Coverage (EOC) for details.
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 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.