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How to Access Covered Care

You can choose coordinated care with your Kaiser Permanente physician or call any provider’s office directly.

For Information about Kaiser Permanente Insurance Company’s (KPIC’s) Network Adequacy Policy, please review our Frequently Asked Questions Document.

Here’s a quick view of getting care with Added Choice and Deductible Added Choice. There are two options to choose from: In-Network and Out-of-Network.

In-Network
Out-of-Network

In-Network

Many ways to access care through Kaiser Permanente.

Depending on your plan, you have access to the Kaiser Permanente Signature^SM Provider Network or the Kaiser Permanente Select^SM Provider Network for the in-network option.

Kaiser Permanente Signature^SM Provider Network

You have access to nearly 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers. A list of network physicians is accessible at kp.org/doctor that allows members to choose and change their doctors at any time, for any reason.
Your care in the Kaiser Permanente Signature network starts with your own personal doctor—your primary care physician—who will coordinate your care. You choose your own doctor and you can change your doctor at any time.
Most specialist visits require a referral, but your primary care physician will typically handle this for you.
You can manage your care at kp.org. Visit anytime from anywhere to make an appointment, refill most prescriptions, see most lab results, and much more.
You could also have a video or telephone visit with a doctor at no extra cost.
Urgent care is available at select Kaiser Permanente medical centers, with some open 24 hours a day, seven days a week.

Kaiser Permanente Select^SM Provider Network (Only available for mid-size and large groups.)

Building on our Signature provider network, Select adds access to contracted community physicians in private practice. Members may choose a physician in the Mid-Atlantic Permanente Medical Group, P.C., or a community physician, and also have access to contracted hospitals located throughout the service area.
Virtually no claim forms to complete.
If you have a network physician, contact your doctor’s office directly.
You can visit kp.org/travel or call the away from home travel line 1-951-268-3900 for all of your options.

You’ll generally pay the lowest out-of-pocket costs when you receive services from in-network providers and facilities.

Out-of-Network

Call any licensed provider’s office directly.

You can call any out-of-network licensed provider for care. To make an appointment, you can call their office directly.
You don’t need a referral for appointments with out-of-network specialists. However, you will need preauthorization for some services and procedures.
When you see an out-of-network provider for the ﬁrst time, let the ofﬁce staff know you are using the out-of-network option of your Kaiser Permanente plan, which lets you see any licensed provider.
Your doctor may require you to pay the full cost of the visit. And you will need to submit claim forms with itemized bills for reimbursement.
You’ll have to pay coinsurance and meet a deductible. You’ll also be responsible for any difference between what your provider charges for service and the payment your insurance plan provides.

You’ll generally pay the highest out-of-pocket costs when you receive services from out-of-network providers and facilities.

It’s important to keep in mind:

Your cost-shares will vary in each provider option.
The amount you pay for a particular service will depend on the provider option you choose and—in some cases—where you choose to receive care.

To find out more:

Your reference guide has details about accessing covered care using the different options.
Refer to your Evidence of Coverage (EOC).
Refer to your ID card or call Customer Service, Monday through Friday, 8 a.m. to 6:00 p.m., Eastern Time, at 1-888-225-7202 (TTY 711).

*The terms of your Evidence of Coverage govern the scope of covered benefits. Certain exclusions and limitations apply.

Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) underwrites the Added Choice Product line.