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Precertification

To ensure that the medical service ordered is medically necessary and the most appropriate treatment for your condition, prior approval may be required. This is known as precertification for services ordered by a Participating Provider or Non-Participating Provider.

What requires precertification?

Kaiser Permanente Plan Providers

Your primary care physician coordinates your care in the HMO Tier.

Participating Providers

For the Participating Providers, some services require precertification to be covered, such as hospital admissions, outpatient surgeries, MRI, CT, and PET scans.
For a complete list of services that require precertification, see your Certificate of Insurance (COI).

How do I receive precertification?

You are responsible for assuring your PHCS provider in CA and other Kaiser Permanente states has obtained precertification when required. If precertification is not obtained, you incur the risk of receiving a penalty up to $500. The penalty does not apply toward your deductible or out-of-pocket maximum. If using the Cigna PPO Network for care in non-Kaiser Permanente states, the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
You or your doctor should call to ask for precertification before you schedule services. You will need precertification for some services and procedures if using the PHCS Network in California or other Kaiser Permanente states. You are responsible for obtaining precertification. You must call 1-888-251-7052 (TTY 711) Monday through Friday, 6 a.m. to 6 p.m. Pacific Time.
If using the Cigna PPO Network for care in non-Kaiser Permanente states, the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
To learn more, review the precertification section in your Certificate of Insurance(COI) for details.

Need precertification?

Call 1-888-251-7052 (TTY 711), Monday through Friday, 6 a.m. to 6 p.m., Pacific time.

Non-Participating Providers

Any licensed provider

For Non-Participating Providers, some services require precertification to be covered, such as hospital admissions, outpatient surgeries, MRI, CT, and PET scans.
For a complete list of services that require precertification, see your Certificate of Insurance (COI).

How do I receive precertification?

You are responsible to obtain precertification. If you fail to obtain precertification, you incur the risk of receiving a penalty up to $500. The penalty does not apply toward your deductible or out-of-pocket maximum. So, it’s important to get precertification.
You or your doctor should call to ask for precertification before you schedule services by calling 1-888-251-7052 (TTY 711), Monday through Friday, 6 a.m. to 6 p.m., Pacific time.
To learn more, review the precertification section in your Certificate of Insurance (COI) for details.

Need precertification?

Call 1-888-251-7052 (TTY 711), Monday through Friday, 6 a.m. to 6 p.m., Pacific time.