Yes. You have access to emergency and urgent care wherever in the world. As a visiting member, you can get most routine and specialty care if you attend school in another Kaiser Permanente territory. Most plans only cover emergency and urgent care if you attend school outside of a Kaiser Permanente location. However, some plans do offer coverage for non-emergency medical visits.
For example, if you have a question about your health care needs that is not an emergency, you could go to a Kaiser Permanente hospital for a checkup or to get a prescription filled. The doctor who sees you will ask you many questions about your health history and may give you instructions on what kind of lifestyle changes you should make to prevent future illness or injury. If you need testing or treatment that is not routine or elective, you may have to pay out of pocket for these services. In this case, you would send payment with your next billing cycle's bill.
Kaiser Permanente in California offers four types of plans: HMO, PPO, EPO, and Self-Funded. An HMO (health maintenance organization) requires you to use only doctors and hospitals within its network. If you need care from a physician or facility that is not part of Kaiser Permanente, you will not be able to receive it.
You are covered for emergency and urgent treatment anywhere in the globe as a Kaiser Permanente member. This leaflet will explain what to do if you require emergency or urgent care while traveling inside the United States or worldwide. For more information about Kaiser Permanente's global network, visit.
However, your coverage may not be accepted by all hospitals in Mexico because they may not be aware that you are a member of Kaiser Permanente. Please check with any hospital you're considering whether its facilities are available for Kaiser members before you travel to Mexico.
While you are temporarily outside of your coverage region, we will cover urgent care in non-Kaiser Permanente facilities anywhere in the United States. We also may be able to help with medical transportation.
However, because this is an emergency treatment situation, there are many factors that will determine how long you can expect to remain covered. For example, our medical decisions must take into account where you need care and what other health problems you have so that we can best decide which hospitals offer the highest quality care for your type of injury or illness.
If your coverage has expired, disappeared, or been cancelled, you should let us know as soon as possible so that we can make appropriate arrangements.
In addition, if you receive benefits through another government agency (such as Social Security), they may have a priority right to determine whether you can go outside of Kaiser for additional coverage. If this is the case, they will tell you what role Kaiser plays in your coverage and what restrictions or limitations may apply.
Finally, if you are enrolled in Medicare and require ongoing medical attention, we would encourage you to keep your enrollment with us. Doing so helps ensure that you have access to the specialists and services that are needed to treat you near your home or community.
Go to the nearest hospital or other institution that can provide you with the treatment you require. Once you return to your coverage region, however, Kaiser Permanente hospitals will be your only option for ongoing care. Additionally, while your coverage is active, you cannot be sent to another institution for treatment.
If you need emergency treatment not offered at your local hospital or clinic, call 911 or go to another institution within our network. However, even if your problem does not appear life-threatening, consider whether an office visit would be appropriate before leaving the coverage area. If so, ask your doctor if they accept Kaiser Permanente health plans.
You should know that if you receive emergency treatment at a facility that does not accept Kaiser Permanente health plans, you could be responsible for any costs that exceed what Kaiser Permanente would have paid had you been treated there.
For example, let's say you go to a non-Kaiser Permanente hospital for emergency gallbladder surgery and the total cost of your stay is $120,000. Kaiser Permanente has specific guidelines for granting financial assistance.
Kaiser Permanente does not often pay providers located outside of the United States directly. If you receive emergency or urgent treatment, you must pay the cost yourself. When you return home, you must file a refund claim. Many governments require payment before providing service. However, these requirements are being changed to allow patients to file claims with their insurance carriers instead.
In most cases, Kaiser Permanente can bill your insurance company for you. Your health plan may have restrictions on how much it will cover and what services are eligible for reimbursement. To ensure that you get full coverage for all recommended tests, treatments, and procedures, please discuss these issues with your health care provider prior to any treatment being given.
If your insurance carrier denies or limits its coverage, you may be able to sue them for damages. The law varies from state to state, but generally speaking, if you feel like you were denied benefits to which you were entitled, you can bring a lawsuit.
In some states, there is also a right of action when someone fails to accept an offer of insurance. This is called "rescission" and means that you can cancel the contract and be returned your money back. Some companies will issue refunds even after you've started treatment if you ask them to do so. Others may not, so it's important to know before you sign up with them that this type of action is allowed in your state.
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