Prior Authorization Approval
Some services ordered by KP Select Providers, PPO Providers, and Non-Participating Providers require prior authorization in order to be covered.
KP Select Providers
- For care with KP Select Providers, your provider will obtain prior authorization, if required, for certain services.
PPO Providers
Certain drugs filled at MedImpact pharmacies may be subject to prior authorization. For a list of drugs requiring prior authorization, please click on this MedImpact Standard Commercial Drug Formulary.
First Choice Health, First Health Network or Cigna HealthcareSM PPO Network1
- Some services, such as inpatient care (for example, hospital surgical procedures) and some outpatient procedures, require prior authorization to be covered.
How do I receive prior authorization?
- Your PPO Provider will obtain prior authorization for you.
- 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.
Non-participating Providers
Any other licensed provider or physician
- For Non-Participating Providers, some services, such as inpatient care (for example, hospital surgical procedures) and some outpatient procedures, require prior authorization to be covered.
How do I receive prior authorization?
- You or your Non-Participating Provider may obtain prior authorization for you or your authorized representative by calling 1-855-281-1840 (TTY 711).
- 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. To learn more, review the prior authorization section in your Evidence of Coverage (EOC) for details.