Precertification

Participating Providers and Non-Participating Providers

• For Participating Providers and 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 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.