Home > Dual Choice PPO > For Members > How to Access Covered Care

How to Access Covered Care

Choose your doctor and change anytime.

Getting in-depth information on how your insurance plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of providers or stay with your current provider. And remember, you can change at any time. Your insurance plan provides you with that flexibility.

Below is an overview of getting care with Dual Choice PPO. You have the option to see Kaiser Permanente Providers in Georgia, Network Providers, or any licensed provider.

For members who have a POS, Out-of-Area PPO, or PPO plan – For Information about Kaiser Permanente Insurance Company’s (KPIC’s) Network Adequacy Policy, please review our Frequently Asked Questions Document

In-Network Providers
Out-of-Network Providers

In-Network Providers

Kaiser Permanente Providers in Georgia & Network Providers

In Georgia: Find Network Providers and Locations

In another Kaiser Permanente State: The PHCS Network provides access to care in the Kaiser Permanente states of CA, CO, HI, MD, OR, VA, WA, and DC.

Non-Kaiser Permanente States: The Cigna Healthcare^SM PPO Network only provides access to care in non-Kaiser Permanente states.

Find Kaiser Permanente Pharmacies in Georgia

Find MedImpact Pharmacies

Hospital Surprise Billing Rating

Kaiser Permanente Providers in Georgia

Many ways to access care through Kaiser Permanente in Georgia.

Kaiser Permanente has 26 convenient locations within Georgia.
Kaiser Permanente providers offer the most coordinated care with the lowest out-of-pocket costs for office visits and pharmacy copayments.
Walk down the hall after an appointment to pick up your prescription, join one of our healthy living classes, or get your lab tests.
Members can also use kp.org and our mobile app to schedule certain appointments, email their doctors, view lab results, and refill prescriptions online.
Find a Kaiser Permanente provider in the Georgia service area, search the Dual Choice PPO Provider Directory

Network Providers

Many ways to access care through Network Providers.

We’ve also contracted with certain network providers to manage your costs, when you are unable to obtain care directly from Kaiser Permanente providers in Georgia.
Services obtained at network providers are subject to a deductible with coinsurance after the deductible has been met.
Certain services including office visits and urgent care are offered at a copay, and preventive care is at no cost.
No referral is needed for office visits to Network Providers or specialists. However, your Network Provider will need to obtain pre-certification with PHCS providers in Georgia and other Kaiser Permanente states of CA, CO, HI, MD, OR, VA, WA and DC for some services and procedures. You are responsible for obtaining precertification. You must call 1-855-265-0311 (TTY 711) for precertification. If using the Cigna Healthcare PPO Network for care in non-Kaiser Permanente states, the Cigna Healthcare PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna Healthcare PPO provider fails to obtain precertification for covered services.
Find a network provider in the Georgia service area, search the Dual Choice PPO Provider Directory
If you live or are travelling outside of Georgia, but in another Kaiser Permanente state (within CA, CO, HI, MD, OR, VA, WA and DC), search here for Network Providers and Locations
If you live or are travelling in a non-Kaiser Permanente state (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), search here for Cigna Healthcare^SM PPO Network provider and locations

Can I nominate a physician to become a Network Provider?

Yes. If you were seeing a doctor who is not a Network Provider, you can nominate the doctor to join the network. Please keep in mind your provider may choose not to be contracted.
To nominate a PHCS provider in GA or another Kaiser Permanente state, visit multiplan.com/kaiser. To nominate a Cigna PPO Network provider outside of Kaiser Permanente, call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday 8a.m. to 6p.m., Eastern time.
Then, enter your provider’s name in the search box and follow the prompts to nominate them to the PHCS network.
The Network Provider Review process can take up to six months. Whether a physician or practitioner is accepted depends on a number of considerations including the provider’s interest in joining, so a nomination doesn’t guarantee acceptance.

Helpful Tips

When making an appointment. Make sure the provider is a Network Provider and is accepting new patients.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card. Make sure the provider only refers you to laboratory, radiology, and other service providers and facilities that are also Network Providers.
After your visit. When you receive care from a Network Provider, you usually do not have to file a claim. Your provider will submit a claim to our claims department. Network Providers are not allowed to bill any balances for covered services. If a network provider bills you for a balance after the appropriate co-payment amount was collected, please contact the Customer Service number on the back of your ID card.

Out-of-Network Providers

Any other licensed provider or physician

Call any licensed provider anywhere for care.

Dual Choice PPO members also have the ability to obtain services from any available provider.
You are free to choose whatever provider you prefer, whenever you receive care.
Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided by your plan.
Your doctor may require you to pay the full cost of the visit. And you will need to submit a Medical Claim Reimbursement Form and itemized bills for reimbursement.
Out of pocket costs are generally the highest with these providers.
No referral is needed for office visits to Out-of-Network Providers or specialists. However, you will need precertification for some services and procedures. You or your authorized representative must obtain precertification by calling 1-855-265-0311 (TTY 711).

Helpful Tips

When making an appointment. Make sure the provider understands that your insurance plan allows you to see any licensed provider.
When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the front of your ID card.
After your visit. When you receive care from an Out-of-Network Provider, you will likely need to submit a claim for reimbursement. You are also responsible for paying amounts that are greater than the maximum allowable charge. You may be required to pay the full amount you are billed when you receive care. If so, you will need to submit a Medical Claim Reimbursement Form with an itemized bill for reimbursement.

You’ll generally pay the most out-of-pocket costs when you receive services from an Out-of-Network Provider or facility.

It’s important to keep in mind:

Your cost-shares will vary between In-Network Providers and Out-of-Network Providers.
The amount you pay for a particular service will depend on the provider you choose and—in some cases—where you choose to receive care.

To find out more:

Refer to your Certificate of Insurance (COI).
Contact the human resources/benefits officer where you work, if your employer provides your coverage.
Call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Eastern time, or refer to your ID card.

Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., underwrites the Dual Choice PPO insurance plan. Some services require precertification. For more information, see your Certificate of Insurance (COI).