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 and First Health Network, or any licensed provider.
You have access to 1,200 Kaiser Permanente doctors and specialists in Oregon and Southwest Washington.
To find providers, locations, and pharmacies, visit the Dual Choice PPO Provider Directory.
Many ways to access care through Kaiser Permanente in Oregon and Washington.
Kaiser Permanente has convenient locations within Oregon and Washington.
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 in the Oregon or Washington service area, search the Dual Choice PPO Provider Directory.
Many ways to access care through First Choice Health and First Health Network
We’ve also contracted with First Choice Health and First Health Network to help manage your costs, when you are unable to obtain care directly from Kaiser Permanente providers in Oregon or Washington.
Find a First Choice Health and First Health Network provider or facility in the Oregon or Washington service area, search the Dual Choice PPO Provider Directory.
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 or First Health 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 First Choice Health Provider Nomination Form.
(TTY 711) or complete and submit theReview 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 part of the First Choice Health or First Health Network and 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 your ID card. Make sure the provider only refers you to laboratory, radiology, and other service providers and facilities that are also a part of the First Choice Health and First Health Network.
After your visit. Your First Choice Health and First Health Network Provider’s office will take care of claim submissions for you.
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. Visit the Dual Choice PPO Provider Directory for a searchable provider directory.
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:
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 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 Member Reimbursement Form 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.
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.