How to Access Covered Care
Get the right care for your needs.
Getting in-depth information on how your insurance plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of providers or stay with your current provider. And remember, you can change at any time. Your insurance plan provides you with that flexibility.
Here’s an overview of getting care with Dual Choice PPO. You have the option to see Kaiser Permanente Providers in Oregon and Washington, First Choice Health, First Health Network, Cigna HealthcareSM PPO Network1, or any licensed provider.
In-Network
Search for Providers
In Oregon and Washington, visit the Dual Choice PPO Provider Directory.
(This is a combined provider and facility directory that contains Kaiser Permanente, direct contracted, First Choice, and network pharmacies.)
In other Kaiser Permanente States (CA, CO, GA, HI, MD, VA, and DC) to find network providers and facilities, visit the First Health Network.
In all other states to find network providers, and facilities, visit the Cigna HealthcareSM PPO Network1 provider directory.
Kaiser Permanente
Kaiser Permanente has convenient locations. Kaiser Permanente providers offer the most coordinated care with the lowest out-of-pocket costs for office visits and pharmacy copayments. Walk down the hall after an appointment to pick up your prescription, join one of our healthy living classes, or get your lab tests. Members can also use kp.org and our mobile app to schedule certain appointments, email their doctors, view lab results, and refill prescriptions online.
Find a Kaiser Permanente provider, search the Dual Choice PPO Provider Directory.
(This is a combined provider and facility directory that contains Kaiser Permanente, direct contracted, First Choice, and network pharmacies.)
First Choice Health, First Health Network, and Cigna HealthcareSM PPO Network1
Many ways to access care through First Choice Health, First Health Network, and Cigna Healthcare PPO Network
We’ve also contracted with First Choice Health, First Health Network, and Cigna Healthcare PPO Network to help manage your costs, when you are unable to obtain care directly from Kaiser Permanente providers.
- Services obtained at First Choice Health, First Health Network, Cigna Healthcare PPO Network are subject to a deductible with coinsurance after the deductible has been met.
- Certain services including office visits and urgent care are offered at a copay, and preventive care is at no additional cost.
- No referral is needed for office visits to First Choice Health, First Health Network, Cigna Healthcare PPO Network or specialists.
- 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 for prior authorization. Failure to get prior authorization may result in greater out-of-pocket cost to you.
Can I nominate a physician to become a First Choice Health and First Health Network Provider?
If you were seeing 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 join our network. Please keep in mind your provider may choose not to be contracted.
To nominate a provider, call 1-866-616-0047 (TTY 711).
Review can take up to six months. Whether a physician or practitioner is accepted depends on several 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 accepting new patients.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card. Make sure the provider only refers you to In-Network providers and facilities.
After your visit. Your In-Network Provider will submit claims on your behalf.
Lower cost shares with enhanced benefits
Some in-network providers, including Kaiser Permanente, have lower cost shares for certain covered services, including primary care, urgent care, specialty care, routine eye exam visits, and mental health and chemical dependency outpatient services. This is referred to as an enhanced benefit.
In-network providers who offer Enhanced Benefits are identified with an asterisk (*) in the provider directory.
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.
Out-of-Network
Any other licensed provider or physician
Call any licensed provider anywhere for care.
Dual Choice PPO members also can get services from any other licensed provider. You can choose whatever provider you prefer, whenever you receive care.
Things to consider:
- Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided by your plan.
- 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.
- Out of pocket costs are generally the highest with these providers.
- No referral is needed for office visits to Out-of-Network Providers or specialists. Some services are accessed through referral and prior authorization. You or your provider must obtain prior authorizationby calling 1-855-281-1840 (TTY 711).
Helpful Tips
When making an appointment. Make sure the provider understands that your insurance plan allows you to see any licensed provider.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card.
After your visit. When you receive care Out-of-Network, you will likely need to submit a claim for reimbursement. You are also responsible for paying amounts that are greater than the maximum allowable charge. You may be required to pay the full amount you are billed when you receive care. If so, you will need to submit a – with an itemized bill for reimbursement.
You’ll generally pay the most out-of-pocket costs when you receive services from an Out-of-Network Provider or facility.
It’s important to keep in mind:
- Your cost-shares will vary between In-Network Providers and Out-of-Network Providers.
- The amount you pay for a particular service will depend on the provider you choose and—in some cases—where you choose to receive care.
To find out more:
- Refer to your Evidence of Coverage.
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time, or refer to your ID card.
Kaiser Foundation Health Plan of the Northwest underwrites the Dual Choice PPO insurance plan. Some services require prior authorization. For more information, see your Evidence of Coverage.
It’s important to keep in mind:
- Your cost-shares will vary between In-Network Providers and Out-of-Network Providers.
- The amount you pay for a particular service will depend on the provider you choose and—in some cases—where you choose to receive care.
To find out more:
- Refer to your Evidence of Coverage.
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time, or refer to your ID card.
Kaiser Foundation Health Plan of the Northwest underwrites the Dual Choice PPO insurance plan. Some services require prior authorization. For more information, see your Evidence of Coverage.