Added Choice
Working With Flexible Choice
As a health care provider, you and your office or organization would work with members within the three Flexible Choice options: HMO (Option 1), Multiplan PPO Network (Option 2), or Out-of-Network (Option 3).
An overview of how Flexible Choice is structured.
Kaiser Permanente’s Flexible Choice gives our members the freedom to choose how they want to receive care and manage their costs. With three Options, they receive care from Kaiser Permanente providers, who practice exclusively at KP Centers (HMO), from a network of participating providers (PPO), or from any licensed provider (out of network).
Joining the PHCS or MultiPlan provider networks.
- If you are interested in joining our PPO, you can apply to become a member of the PHCS or MultiPlan network.
- You might also be nominated by a Flexible Choice member.
- Providers who agree to join our networks and meet our requirements will become active within 90 to 180 days.
- To learn more, about joining our provider network, visit multiplan.com/kpmas.
- You can also call the MultiPlan provider information line at 800-220-6010, Monday through Friday, 8 a.m. to 8 p.m.
HMO
As a Permanente physician in the Mid-Atlantic Permanente Medical Group, P.C.
- Option 1 is the in-network HMO option of Flexible Choice.
- Members receive services through the Signature Plan. Treatment and care are coordinated by Permanente physicians and delivered at the KP Centers.
- This care option is managed by Kaiser Foundation Health Plan of the Mid-Atlantic States.
Multiplan PPO Network
As a preferred provider through the Private Healthcare Systems (PHCS) or MultiPlan Network.
- Members may choose to receive care at any time from PHCS or MultiPlan participating providers. With this Option, a member may contact the provider’s office directly with no referral required.
- Most of the time, the member will pay co-insurance and meet a deductible.
- The provider’s office generally will complete and submit claim forms.
- Inpatient and certain outpatient services require precertification.
- This care option is fully underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc.
- KPIC has contracted with the networks to manage costs. There’s no balance billing.
Out-of-Network
As a licensed provider out of network (non-participating providers).
- Members may choose at any time to see any licensed provider to receive care. With this Option, a member may contact the provider’s office directly with no referral required.
- Most services are subject to a deductible and coinsurance.
- Inpatient and certain outpatient services require precertification.
- Members will probably need to submit claims for reimbursement. They are also responsible for paying amounts greater than the maximum allowable charge.
- This care option is underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc.