Authorizations

Cigna Healthcare PPO

Network Providers for urgent or emergency care outside of Kaiser Permanente's service state (California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at Kaiser Permanente's dedicated phone line for Cigna Healthcare PPO providers: 888.831.0761.Adverse benefit decisions can be appealed by following the instructions on the back to the member’s Adverse Benefit Determinations notice:Authorization Details for an HMO, EPO, POS 2-Tier Member:

Cigna Healthcare PPO Network Providers for urgent or emergency care outside of Kaiser Permanente's service state (California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at Kaiser Permanente's dedicated phone line for Cigna Healthcare PPO providers: 888.831.0761.

Adverse benefit decisions can be appealed by following the instructions on the back to the member’s Adverse Benefit Determinations notice:

Cigna Healthcare PPO Network Providers should check eligibility and benefits to determine covered services, send claims, and submit precertification requests as instructed on the ID card.

Cigna Healthcare PPO Network Providers providing care outside of Kaiser Permanente states (outside of California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at Kaiser Permanente's dedicated phone line for Cigna Healthcare PPO providers: 888.831.0761.

Adverse benefit decisions can be appealed by following the instructions on the back to the member’s Adverse Benefit Determinations notice:

Cigna Healthcare PPO Network Providers should check eligibility and benefits to determine covered services, send claims, and submit precertification requests as instructed on the ID card.

Cigna Healthcare PPO Precertification List

Below is a general list of procedures for members on an OOA/PPO/3-Tier POS plan that require a Cigna Precertification when using in-network benefits outside of a KP State:

Procedure	Pre certification requirements	Procedure	Pre certification requirements
Chiropractic Services	Yes	Physical and Occupational Therapy	No, but benefit limits apply
Cochlear Implants	1No, but benefit limits apply	Diagnostic Radiology	Yes
DME/Orthodontics & Prosthetics	Yes	Erectile Dysfunction	Yes, pharmacy benefit exclusions may apply & should be requested through MedImpact
Gastric Bypass	Yes	Home Health Care	Yes
Home Infusion Therapy	Yes	Injectable Medication	Yes
Oral Pharynx Procedures	Yes	Outpatient Procedures	Yes
Potential/Experimental	Yes	Speech Therapy	No, but benefit limits apply
Investigational/Unproven
Spinal Procedures	Yes	Therapeutic Radiology	Yes
Transplants	Yes, Kaiser Permanente UM approval is required	Unlisted Procedures	Yes, benefit exclusions may apply

Click on the following link to view the complete list of services that require precertification.

Note: Please be advised that Kaiser Permanente members are not subject to Cigna’s entire list of services that require a precertification & its entirety. As described above Cigna Healthcare PPO providers are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at 888.831.0761.

*The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Intellectual Property, Inc.

**Eligibility Exceptions: The Cigna Healthcare PPO Network* enhanced experience for our members is not available to:

HMO, EPO, PPO, & POS members enrolled in coverage issued by Kaiser Foundation Health Plan of Washington and Kaiser Foundation HealthPlan of Washington Options, Inc.
PPO and POS 3-Tier members enrolled in coverage issued by Kaiser Foundation Health Plan of Northwest.
Medicare members
Medicaid members (Medi-Cal in California)

***Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP).