Member Support and FAQs

For care within all Kaiser Permanente states (CA, CO, GA, HI, MD, OR, VA, WA, and the District of Columbia), you can search all available providers and facilities which includes Kaiser Permanente (Option 1) providers, and Private Healthcare System and MultiPlan (Option 2) providers in the Flexible Choice Provider Directory.

For care outside of Kaiser Permanente states, you can search the Cigna Healthcare PPO Network (Option 2) for providers.

FYI – Any other licensed provider not shown in these directories are considered Option 3 providers. You have the right to see any licensed provider under your plan, but you will likely pay a higher cost-share to see providers outside the Option 1 and 2 network.

Note: For any questions or help locating providers or facilities in any state, contact the Customer Service number on your ID Card at 1-888-225-7202 (TTY 711).

Option A – Electronic Claim Reimbursement Process

Step 1: After you have received your service and paid the provider, go online to kp.org, sign in, and submit a claim reimbursement. The following steps will indicate which information is required to submit a claim.

Note: Before reimbursement can be provided, the receipt showing the service was paid for must also be submitted.

Step 2: After you sign in to kp.org, navigate to the “Coverage and Costs” section, then select “Submit a Claim.” This will direct you to the specific form that needs to be completed.

Step 3: Click through and complete the online form as directed. Below is a screenshot of a portion of the form that needs to be completed. As you click through the form, additional instructions will pop up.

Step 4: After you have submitted your documentation, click “Submit” and you will receive a pop-up confirmation that the claim has been submitted successfully.

Step 5: Once the claim has been entered into Kaiser Permanente’s system, you will receive a status email from Kaiser Permanente. You can track the status of your claim from the “Visit Cost Summary” section on kp.org. Here is a sample status email from Kaiser Permanente:

Option B – Print & Mail in Claim Reimbursement Process

Step 1: After you have received your service and paid the provider, print and mail the following claim form to the address mentioned on the form. The form indicates the required elements needed to submit a reimbursement, including the receipt showing the service was paid for, before reimbursement can be provided.

Step 2: Click here for Medical Claim Form then, print, fill out your details, and mail the form to the address indicated at the bottom of page 2 for the MD, DC, or VA members Claim address. Please call the Customer Service number on the front of your ID Card at 1-888-225-7202 (TTY 711) if you have any questions.

Option A – Proactive

Step 1: Before services are needed, call the Customer Service number on your ID Card at 1-888-225-7202 (TTY 711)

Step 2: Let Customer Service know that you need help navigating and understanding the resources available to you for complex care scenarios, including bringing in external lab or radiology orders into KP.  Customer Service will do a handoff to a specialized internal support team that will follow-up with you within the next business day to help you understand your plan design and help you decide how you want to move forward based on your options. Customer Service will provide your name, medical record number (MRN), and contact number to the internal team to follow-up with you.

Option B – Reactive

Step 1: If you need help during care, and identify an authorization is needed that is slowing down your care journey, please call the Customer Service number on your ID Card at 1-888-225-7202 (TTY 711). Generally, it is the provider’s responsibility to get authorization, but Customer Service can confirm if authorization is needed based on the service/procedure needed and direct you on the next steps.

Option A – Ask Kaiser Permanente to help educate Network (Option 2) Provider

Step 1: Call the Customer Service number on your ID Card at 1-888-225-7202 (TTY 711).

Step 2: Let Customer Service know that you are seeing a PHCS/MultiPlan or Cigna Network (Option 2) provider, but the provider is requesting full payment for the service or is requesting payment before care is provided.

Customer Service will confirm the provider is an Option 2 Network provider. If so, they will submit an internal request to educate the provider to bill Kaiser Permanente so you do not have to pay everything up front. You should only pay your cost-share (i.e. copay, deductible, and/or coinsurance) for the service after care has been provided to you. Customer Service will provide your name, MRN, the provider’s name and location, and contact information to the internal team.

Step 3: A Kaiser Permanente team member will reach out to the provider on how they bill Kaiser Permanente for the service and that the provider should only collect your cost-share from you. The Kaiser Permanente team member will then follow-up with you on the result within the next business day.

Option B: Pay full cost up front and then submit claim reimbursement to Kaiser Permanente

Step 1: You may choose to pay upfront and submit a claim reimbursement to Kaiser Permanente after you have received the service and have a receipt to show it was paid for.

Note: You will not be asked to submit claim forms for services received at a Kaiser Permanente facility.

Step 2 (Electronic claim submission): You can electronically submit a claim reimbursement request on kp.org after signing in. Navigate to “Coverage and Costs,” then select “Submit a Claim.” This will direct you to the specific form that needs to be completed. You will need to upload a copy of the receipt.

OR

Step 2 (Print and mail claim submission): To mail in a claim reimbursement request, you can print and mail in a medical claim form. You will also need to provide a copy of the receipt. Click here for Medical Claim Form. After accessing the form, print it out, fill out your details, and then mail the form to the address indicated at the bottom of page 2 for the DC, MD, or VA Claims address. Please call the Customer Service number on the front of your ID Card at 1-888-225-7202 (TTY 711) if you have any questions.