Frequently Asked Questions About Kaiser Permanente
These are answers to some common questions from members, arranged by category. If you don't find the help you need, contact Member Services.
- Obtain care from certain out-of-network providers at in-network cost-sharing
- Obtain care without a referral in cases where a referral would normally be required
- Obtain Part D medication refills sooner and in larger quantities than typically allowed
You may view profiles of doctors and other providers in the Provider Directory.
Submit your choice online: To choose your primary care provider online, you must sign on. In the Provider Directory, click on the name of the provider you want, and the blue button called “Select as PCP" will open a short form for you to fill out and submit.
By phone: You also may call Member Services during business hours, Monday through Friday, to designate a personal physician.Choose or Change Your Personal Physician
You may change your primary care doctor at any time. Just select someone else as your personal physician. Sign on, go to that doctor's profile page in the Provider Directory, and submit the online form called "Make this doctor my personal physician." You also may change personal physicians by calling Member Services.
Also see, Choose or Change Your Personal Physician
If you want to see a doctor at a Kaiser Permanente medical offices location, call the medical center where the doctor is based. If you are registered on the Kaiser Permanente member website, you can schedule the appointment online by signing on and going to the Appointments link on your secure home page.
If you want to see a doctor in our network (doctors who don't work at a Kaiser Permanente-owned clinic), call that medical clinic to make an appointment. If you are seeing a specialist in the network, you may need a referral, also called an authorization.Making Appointments
Kaiser Permanente members can make appointments directly with most specialists at Kaiser Permanente medical offices locations without a referral (authorization) from their personal physician.
To see a contracted or network specialist who doesn't work at a Kaiser Permanente-owned facility, an authorization from your health plan may be needed.How to Get Specialty Care
In a life-threatening situation, always call 911.
For non-life threatening situations after hours, call our Consulting Nurse Service. (The number also is on the back of your Kaiser Permanente member ID card.) The consulting nurse will give you advice on how to best treat your condition and, when necessary, recommend that you go to a Kaiser Permanente Urgent Care Center or an emergency room.
If your question or concern is not urgent, you can sign on to this site and send a secure e-mail message, either to your health care team or to our Consulting Nurse Service. You should get a reply by the end of the next business day. (You must be registered on Kaiser Permanente member website to access these services.)Consulting Nurse Service
If you are injured on the job, tell your employer immediately and complete any necessary internal forms.
When you first visit your doctor for this injury, tell the medical receptionist that you have a work-related injury. Be sure to complete workers' compensation forms, including a report of the accident. This will help us bill the appropriate insurance carrier. If you have questions about on-the-job injury claims, contact Member Services.
If the Governor of Washington, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to coverage from your plan.
Generally, during a disaster your coverage will be temporarily expanded and allow you to:
When the disaster is over (as announced by government officials or, if there is no announcement, 30 days after the disaster was declared), plan benefits and policies return to normal.
If you have questions about coverage during a disaster, please call us.
Mon.-Fri., 8 a.m.-5 p.m.
Medicare Member Services
TTY WA Relay
1-800-833-6388 or 711
Mon.-Fri., 8 a.m.-8 p.m.
Extended hours (Medicare Member Services)
Oct. 1 - Feb. 14
8 a.m. - 8 p.m.
7 days a week
When you enrolled, you received a benefit summary (also called a certificate of coverage) that lists most covered services. If you are registered on Kaiser Permanente member website, you can sign on and see information for specific visits in the Health Coverage area. The Benefits Usage Status link shows how much of your optical or other benefits have been used in the current year.
If you have a coverage question that is not answered in the benefit summary, or you are unsure of what your plan covers, contact Member Services.
Most plans cover prescription drugs. Sign on and check your certificate of coverage or other coverage agreement for your prescription benefits.
If you have questions about whether a prescription you are currently taking will be covered, check our online Drug Formulary.About Our Drug Formulary
You have 60 days after a baby's birth to register your child for coverage. If you receive coverage through your employer, contact the benefits or personnel department where you work to add your child.
If you're on a plan that you purchased directly (not through an employer), see the Individual and Family Plans section.
If your coverage is through the Washington Basic Health Plan, go to the Washington Health Benefit Exchange website for contact information.
Kaiser Permanente members are covered for emergency and urgent care while traveling anywhere in the world. This coverage is described in your Kaiser Permanente certificate of coverage or medical coverage agreement.
If you or a family member is admitted to a hospital while traveling, you must call our Hospital Notification Line at 1-888-457-9516 within 24 hours to notify us or to request follow-up care.
While traveling outside the Kaiser Permanente coverage area in the United States, some of our health plans provide care at Kaiser Permanente facilities. Check your coverage.When You Are Traveling
If you receive your coverage from your employer, contact your benefits or personnel department at work to see if you are eligible for dental benefits. Members on most individual and family plans and on Medicare plans have the option to include dental coverage when they enroll in medical coverage.Dental Coverage
Your employer determines the end date of your coverage and notifies Kaiser Permanente. Contact your employer for information about any continuation of benefits (such as COBRA) that may be available to you.
You may also enroll in one of our individual and family plans.Individual & Family Plans
Kaiser Permanente members who attend college in Washington are covered at Kaiser Permanente facilities in western Washington and the Spokane area, and through our networks in those areas, if included in your health plan.
Members attending schools in other states are covered for urgent and emergency care only. Check your certificate of coverage because the age for qualifying as a dependent varies between plans.
You have several options for paying bills. To pay online, you must be registered with Kaiser Permanente member website and sign on. Go to Medical Bills on your secure home page.Billing Statements and Payments
Kaiser Permanente's Patient Financial Services will generate a billing statement and send it to you. (You can opt out of receiving a paper bill by signing on, going to Medical Billing on your secure home page, and choosing paperless.)
If the account is not paid in full at the time of the first mailing, a second bill will be sent 30 days later. Subsequent bills will be sent every 30 days until the balance is paid in full. Unless the account is in dispute, the bill will be turned over to a collection agency after four mailings. If you have difficulty paying a bill, you can request financial assistance.Billing Statements and Payments