Home > Added Choice > For Members > Prior Approval

Prior Approval

To ensure that the medical service ordered is medically necessary and cost effective, prior approval may be required. This is known as prior authorization for services ordered by a Kaiser Permanente Provider or Out-of-Network Provider.

What requires prior authorization?

In-Network Provider Tier
Out-of-Network Provider Tier

In-Network Provider Tier

For care with Kaiser Permanente Providers, your provider will arrange for prior authorization, if required, for certain services.

Out-of-Network Provider Tier

For the Out-of-Network Providers, some services require prior authorization to be covered, such as inpatient care (for example: hospital surgical procedures) and some outpatient procedures.

How do I receive prior authorization?

Your Out-of-Network Provider may obtain prior authorization for you or your authorized representative by calling 1-855-265-0311 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m., Eastern time.
To learn more, review the prior authorization section in your Evidence of Coverage (EOC).

Need prior authorization?

Call 1-855-265-0311 (TTY 711)