Dual Choice PPO
Precertification
To ensure that the medical service ordered is medically necessary and cost effective, prior approval may be required. This is known as precertification for services ordered by In-Network Providers or Out-of-Network Providers.
What services require precertification and how to obtain it?
In-Network Providers
Kaiser Permanente Providers in Georgia & Network Providers
What services require precertification and how to obtain it?
Kaiser Permanente Providers in Georgia
- For care with Kaiser Permanente Providers in Georgia, your provider will arrange for precertification, if required, for certain services.
Network Providers
- For care with PHCS Network Providers in Kaiser Permanente states of CA, CO, GA, HI, MD, OR, VA, WA and DC, some services require precertification to be considered for payment under your insurance plan, such as inpatient care (for example: hospital surgical procedures), and some outpatient procedures. 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 must call 1-855-265-0311 (TTY 711)
- To learn more, review the precertification section in your Certificate of Insurance (COI) for details.
Need precertification?
Call 1-855-265-0311 (TTY 711)
Out-of-Network Providers
Any other licensed provider or physician
What services require precertification and how to obtain it?
- For care with Out-of-Network Providers, some services require precertification to be considered for payment under your insurance plan, such as inpatient care (for example: hospital surgical procedures), and some outpatient procedures.
- You or your authorized representative must obtain precertification by calling 1-855-265-0311 (TTY 711).
- If you don’t obtain precertification for services with Out-of-Network Providers, you may have to pay the entire expense.
- To learn more, review the precertification section in your Certificate of Insurance (COI) for details.
Need precertification?
Call 1-855-265-0311 (TTY 711)