How to Access Covered Care
With the Kaiser Permanente PPO Plus® plan, you’ll have the freedom to choose any doctor or hospital you want, anywhere in the country.
With PPO Plus®, you choose from the PPO Provider Network or Non-participating Providers.
PPO Provider Network
We provide many ways to access care through PPO Providers.
To find a PPO Provider or confirm if your current provider is part of the PPO Provider network, please visit our customized locators.
First Choice Health Network
(Members receive care in OR, WA, ID, MT, WY, ND, SD, and AK.)
First Health Network
(Members receive care in all states EXCEPT OR, WA, ID, MT, WY, ND, SD, and AK.)
- Most First Choice Health or First Health 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. You will need prior authorization for some services and procedures. Your PPO Provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization will result in greater cost to you.
- It is always a good idea to call the provider’s office to confirm they are a PPO Provider.
Can I nominate a physician to become a PPO provider?
- Yes. If you were seeing a provider who is not part of the First Choice Health or First Health Network before you became a member, you can nominate that provider to join the PPO Provider Network. Please keep in mind your provider may choose not to join the PPO Provider Network.
- To nominate a PPO provider, contact Customer Service at 1-866-616-0047 (TTY 711).
- Review can take up to 6 months. Whether a provider 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 making an appointment. Make sure the provider is a PPO Provider (that is, part of the First Choice Health or First Health Network or Kaiser Permanente) and is accepting new patients.
- When checking in for your visit. Bring your PPO Plus® ID card with you. If your provider has any questions, have them call Customer Service. All referrals should be to PPO Providers. You can request your PPO Provider to 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 PPO Provider. Contact an PPO Plus® Navigator at 503-813-3981 for assistance or to learn more.
Kaiser Permanente providers
- Choose a provider from Kaiser Permanente in Oregon and Washington (Clark and Cowlitz counties). You can make an appointment online at kp.org or by calling >1-866-616-0047
- You can manage care at kp.org.
- Log in anytime from anywhere to make routine appointments and see most lab results, and much more.
- Video or telephone visits with a doctor are available at no extra cost to most PPO Plus® members. Members with a health savings account (HSA)–qualified high-deductible health plan (HDHP) will pay a charge for scheduled phone and video visits subject to your plan’s deductible.
Non-participating Providers
Any other licensed provider. Call any licensed provider’s office directly.
- Your Non-participating Provider network benefits cover care you receive from any licensed provider (outside the PPO Provider Network).
- You can call the Non-participating Provider’s office directly to make an appointment.
- Most Non-participating 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 will need prior authorization for some services and procedures. You must call 1-855-281-1840 (TTY 711) for prior authorization.
- Your Non-Participating Provider 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 PPO Plus® ID card with you. If your provider has any questions, have them call Customer Service.
After your visit. Some Non-Participating Providers will require you to submit the claim. You will be responsible for paying the cost difference.
You’ll pay the most out-of-pocket costs when you receive services from a Non-participating Provider or facility.
For more information, see your Evidence of Coverage (EOC). For its PPO Provider Network, Kaiser Permanente has contracted with First Choice Health and First Health Network. The list of First Choice Health or First Health Network providers is subject to change without notice. Some services require prior authorization.
Your share of the cost will vary dependent on your provider.
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).