Prior Approval

To ensure that the medical service ordered is medically necessary and cost effective, prior approval may be required. This is known as prior authorization for services ordered by a Kaiser Permanente Provider or Out-of-Network Provider.

What requires prior authorization?

• In-Network Provider Tier
• Out-of-Network Provider Tier

In-Network Provider Tier

• For care with Kaiser Permanente Providers, your provider will arrange for prior authorization, if required, for certain services.

Out-of-Network Provider Tier

• For the Out-of-Network Providers, some services require prior authorization to be covered, such as inpatient care (for example: hospital surgical procedures) and some outpatient procedures.

How do I receive prior authorization?

Your Out-of-Network Provider may obtain prior authorization for you or your authorized representative by calling 1-855-265-03111-855-265-0311

Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP)

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