Most Kaiser Permanente plans require members to make copayments directly to the provider. Copayments for office visits, pharmacy services, emergency room care, and inpatient hospital care can be found online if you are registered through One Health Port to access Kaiser Permanente.
For members on Medicare hospice plans or contracts, copayment applies to non-hospice services only.
You should collect copayments from our members at the time service is provided. You may charge interest, a reasonable billing fee, or both on unpaid copayments as stated in your office policy. The exceptions are Medicare and Medicaid enrollees, for whom it is against federal regulation to collect such fees.
Never collect a copayment from approved Medicaid enrollees; it is against federal regulation to collect such fees.
You should collect copayments for office visits only when the member sees a physician, physician's assistant, or nurse practitioner. There is no copay for seeing a lab technician.
Some group plans cover preventive care visits in full. If a member is on such a plan, do not collect a copayment.
Outpatient services requiring copayments
- Audiology/hearing tests
- Family planning, prenatal, post-partum visits, and prenatal tests (but not if the provider bills globally)
- Injectable medications that may be self-administered at home
- Office visits and consultations
- Pharmacy services
- Physical, occupational, and speech therapies
- Radiation therapy and chemotherapy (except PEBB)
- Emergency room visits where there is no hospital admission
- Most mental health and substance use disorder visits
Outpatient services generally not requiring copayments
- Diagnostic radiology, ultrasound, and lab services. Exception: High-end radiology may have a copayment.
- EEG and EKG cardiac tests
- Preventive care visits, depending on the group plan
- Injections and immunizations except injectable medications that may be self-administered at home
- Nursing home services
- Pulmonary function tests
- Visiting nurse services
- Psychological tests
- Methadone treatment
Contact the Provider Assistance Unit (PAU) with questions about copayments.
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