Preauthorization
Before you can schedule certain healthcare services you may need to get preapproval from your insurance company. This is called preauthorization.
Preauthorization helps make sure you get the right care and the best quality of care when you need services. With preauthorization, you also know that the benefits and costs of your plan are being managed well.
What requires preauthorization?
Some out-of-network services requires preauthorization to be covered, such as inpatient care (such as hospital surgical procedures) and some outpatient procedures.
How do I receive preauthorization?
- In-Network: Some services may require preauthorization. If you have a Kaiser Permanente doctor, he or she will obtain preauthorization for you. If you have a SelectSM network physician, you may be responsible for obtaining preauthorization.
- Out-of-Network: Some services require preauthorization. You will be responsible for obtaining preauthorization.
- For a preauthorization from the Kaiser Permanente Utilization Management Department, call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday, 7:30 a.m. to 9 p.m., Eastern time.
- To learn more, review the preauthorization section in your Evidence of Coverage (EOC) for details.
If you don’t obtain preauthorization prior to receiving in-network or out-of-network services, and the services are deemed not medically necessary, you may have to pay the entire expense. You may also have to pay a penalty, have your benefits reduced, and not have the expenses apply toward your deductible. So, it’s important to get preauthorization. To learn more, review the preauthorization section in your Evidence of Coverage (EOC) for details.
Need preauthorization?
Call 1-888-225-7202 (TTY 711)