We define an emergency as "the sudden, unexpected onset of a medical condition that — in the reasonable judgment of a prudent lay person — is of such a nature that failure to render immediate care by a licensed medical provider would place the member's life in danger or cause serious impairment to the member's health."
In life-threatening situations, provide care without prior authorization. A medical provider will screen the patient as he or she arrives at the emergency department. If a condition is emergent, providers must render treatment immediately, without prior authorization.
Contact the member's personal physician or primary care provider when sending or admitting the patient to an emergency department.
Call the Emergency Patient Resource and Options Program (EPRO) at 1-800-337-3197 prior to admission.
Non-emergent or stable conditions
You may either direct the member to his or her personal physician or contact Kaiser Permanente prior to treatment to obtain pre-authorization. If you do not obtain pre-authorization, we may not cover the treatment. For non-emergent questions, contact the Consulting Nurse Service. If the member has not selected a personal physician or you are unable to reach the physician's office, contact:
Emergency Patient Resource and Opportunity Program