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Member Guide | KP Sound Choice Plans

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Member Guide | KP Sound Choice Plans Member Guide Kaiser Permanente SoundChoice Plans kp.org/wa 1 Kaiser Permanente SoundChoice Plans | Important phone numbers Important phone numbers Member Services Mental Health Access Center 1-888-901-4636 1-888-287-2680 206-630-4636 206-901-6300 711 (TTY) Schedule first-time appointments for mental Get information about: health and addiction and recovery services. • Getting care. Choosing or switching doctors, Care Management services where to go for care, referrals for specialists, and on-the-job injuries. 1-866-656-4183 Get help managing chronic health conditions. • Coverage. What your health plan does and doesn’t cover, billing questions, and coverage Hospital Notification Line while traveling. 1-888-457-9516 • Billing. Statements, payments, and Call if you’ve been hospitalized for reimbursements. an emergency. • Language services. If your primary language is not English. Prescription refills • Evidence of Coverage. If you need a printed 1-800-245-7979 copy of this document. Sign in at kp.org/wa/pharmacy or call us to order refills or transfer prescriptions. New Member Welcome Team 1-888-844-4607 Resource Line 206-630-0029 1-800-992-2279 Get help transferring your care or prescriptions Get information on health topics, community to Kaiser Permanente. resources, services for seniors, and support groups in your area. Consulting Nurse Service 1-800-297-6877 Website and mobile app support 206-630-2244 1-888-874-1620 Get health care advice 24 hours a day, Monday through Friday, 8 a.m. to 5 p.m. 7 days a week. Get help with our online services. Find forms, health information, and providers in your plan online at kp.org/wa. Register for personal online services and you’ll be able to check your health coverage and benefits, order prescription refills, complete a health risk assessment, and more. 2 Kaiser Permanente SoundChoice Plans | Contents Your Kaiser Permanente Member Guide Welcome to your go-to source for understanding your care options, finding health resources, and more. Getting and staying healthy starts with taking advantage of all that Kaiser Permanente has to offer. Contents Your member ID card ........................... 3 Staying well Resources for healthy living ........................ 13 Your care Preventive care .............................................. 14 Choose your doctor ....................................... 4 Routine care and care advice ...................... 5 Be informed Specialty care .................................................. 6 Protecting your privacy and security ...... 15 Urgent and emergency care ....................... 7 Your medical treatment .............................. 16 Getting prescriptions filled .......................... 8 Coverage decisions ..................................... 18 Supportive care services .............................. 9 Your rights and responsibilities ................ 20 Managing your health online .................... 10 Definitions you should know ..................... 23 Care away from home ................................. 11 Nondiscrimination notice and language access services ........................... 25 Paying for your care ..................................... 12 The information in this Member Guide is updated from time to time and is current as of November 2020. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. If you have questions, or to get the latest information, call Member Services or visit kp.org/wa. 3 Kaiser Permanente SoundChoice Plans | Your member ID card Your member ID cardKaiser Foundation Health Plan of Washington RxBIN 610011 RxPCN IRX Your Kaiser Permanente member ID card will CoSoundChoicere RxGrp GCOCOMM be mailed to you. You need your member ID TEMPORARY ID CARD card or ID number to: Kaiser Foundation Health Plan of Washington ID number Your name • Medical advice: Call 24/7 Reimbursement for Get care at our facilities and with other Consulting Nurse Service claims: Claims Processing RxBIN 610011 1-800-297-6877. PO Box 34585 plan network providers RxPCN IRX Seattle, WA 98124 CoSoundChoicere Life-threatening RxGrp GCOCOMM emergency: Call 911 or Member Services: local emergency number. 206-630-4636 or • Fill prescriptions TEMPORARY ID CARD Admitted to a hospital: 1-888-901-4636 Call 1-888-457-9516 within (WA TTY Relay • Sign in at kp.org/wa to use personal 24 hours or as soon as 1-800-833-6388 or 711) possible after admission. Electronic Payer ID: 91051 Medical advice: Call 24/7 Reimbursement for online services Consulting Nurse Service claims: Claims Processing kp.org/wa 1-800-297-6877. With preauthorizationPO Box 34585 XB0001323-50-17 • Get assistance from Member Services Life-threatening Seattle, WA 98124 emergency: Call 911 or Member Services: local emergency number. 206-630-4636 or Admitted to a hospital: 1-888-901-4636 Call 1-888-457-9516 within (WA TTY Relay 24 hours or as soon as 1-800-833-6388 or 711) Digital ID card lets you manage possible after admission. Electronic Payer ID: 91051 kp.org/wa your care on the go HelpfulWith preauthorization tips XB0001323-50-17 You can also access your membership Check out the back of your card. You’ll find information anytime, anywhere, with the useful numbers such as the Consulting Nurse Kaiser Permanente digital ID card — an Service, Member Services, and the number electronic version of your ID card. Just register to call if you’re admitted to a hospital. for online services, sign in, and find the link Call Member Services immediately if your ID on your secure homepage. The digital card card is lost, stolen, or needs to be replaced. lets you check in for appointments, pick up prescriptions, and provide your membership Write down your member ID number and keep information — right from your smartphone. it in a safe place separate from your card. Download the Kaiser Permanente Washington app. It’s as easy as 1, 2, 3 1. Register for online services at kp.org/wa/getstarted. 2. Download the Kaiser Permanente Washington app from the app store on your mobile device. Make sure the app you download has WA on the icon. 3. Sign in with your member ID and manage your health care anytime, anywhere. 4 Kaiser Permanente SoundChoice Plans | Your care | Choose your doctor Choose your doctor and change anytime Even if you don’t need to see a doctor right away, having a personal physician is an important part of taking care of your health. Your personal physician coordinates your overall health care and makes sure you’re connected with the resources you need. Choose the right doctor What to consider when you choose a doctor To find a personal doctor who’s right for you, you can call Member Services or browse Make a list of what’s important to you in our online doctor profiles. There you’ll see a doctor. Here are some things to consider: information on each doctor’s education, gender, clinic location, medical interests, credentials, specialties, and areas of interest. languages spoken, years of experience, For your personal physician, choose from cultural or personal background. these specialties: • Family medicine Make an appointment • Adult medicine/internal medicine Call the doctor’s office to schedule an • Pediatrics/adolescent medicine appointment. At the appointment, talk (for children up to 18) with your doctor about your medical history, Be sure to check that the doctor you’re including any current conditions, known considering is accepting new patients. If your health risks, and medications you’re taking. choice doesn’t feel right after a few visits, you Review our preventive care schedules at can change personal doctors at any time, for kp.org/wa/wellcare and schedule any any reason. immunizations, tests, or screenings you’re If you don’t choose a doctor when you first due for. become a Kaiser Permanente member, we will If you’ve chosen a personal physician at a match you with a physician to make sure you Kaiser Permanente facility, you can schedule an have a doctor assigned to you if you get sick appointment online once you’ve registered for or injured. our secure member website. Help for new members Are you in the middle of treatment? If you need help transferring your care or prescriptions from other providers and pharmacies to Kaiser Permanente, call our New Member Welcome Team at 206-630-0029 or 1-888-844-4607. 5 Kaiser Permanente SoundChoice Plans | Your care | Routine care and care advice Routine care and care advice We want it to be easy for you and your family to get the care you need, so we offer online, phone, and face-to-face options. Choose what works best for your health needs. For more information, visit kp.org/wa/getcare. Online Phone appointment* Doctors at Kaiser Permanente medical facilities E-visit* often schedule phone appointments with Get an online treatment plan for common health established patients for health concerns or issues, plus a prescription if needed. Start an follow-ups that don’t require an in-person visit. e-visit anytime and get a response from 9 a.m. to 9 p.m. daily. Walk-in clinics Care Chat* Chat online with a Kaiser Permanente Find hours for walk-in clinics at a number of clinician to get immediate care, treatment, our medical facilities (Everett, Olympia, and prescriptions, if necessary. Care Chat is Puyallup, Tacoma, and Riverfront in Spokane) available 24/7. at kp.org/wa/locations. No appointment is needed. Video visit* Meet face-to-face with a Kaiser Permanente clinician by video for high-quality, personalized Office visits care. Same-day or next-day appointments are Call your personal physician’s office to often available. schedule routine visits for preventive care Email your care team or to discuss symptoms or health issues. If you get your care from Kaiser Permanente At Kaiser Permanente, we’ll make every doctors and care teams, you can email them effort to get you an appointment with your with nonurgent medical questions, and get a personal physician at a convenient time. response within 2 business days.
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