Referring Kaiser Permanente members for specialty care and services
Referring for specialty care
When appropriate, you may need to refer a patient for specialty care and services. When referring a Kaiser Core member, you should always refer to a network specialist. You can use the provider directory to determine who is in network for your patient's plan.
Please see Prior authorization requirements and management guidelines as well as Follow-up care with a specialist to access referral authorization guidelines.
The use of non-contracted providers for a Kaiser Permanente Core member
A provider may use or order services from other physician groups, facilities, or vendors in the course of patient care. Contracted and network entities should always be used for Kaiser Core members in these instances. The use of non-contracted providers without the proper authorization from Kaiser Permanente may lead to a denial where we are unable to protect our members from balance billing or for being held financially liable for the full charge.
Examples of this may include (but are not limited to):
A lab test that is ordered and drawn at a contracted laboratory but is sent to a non-contracted pathology vendor for analysis.
A GI scope where monitored anesthesia is used with a non-contracted anesthesiologist but the member does not meet criteria for that level of anesthesia.
A nebulizer is given to a member from an on-site supply closet that is stocked by a non-contracted vendor.
A member is referred by a PCP to non-contracted specialist and no pre-authorization is obtained.
It is our expectation that our contracted providers work with us to ensure the best care and coverage for members.
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