Kaiser Permanente Insurance Update

As of March 1, 2024, Kaiser Permanente (KP) members in Boulder County have more care options closer to home thanks to two new agreements with Boulder Community Health (BCH) and the Boulder Valley Care Network (BVCN).

For questions on providers, care, and coverage, Kaiser Permanente encourages you to call the customer service phone number on your ID card. Here are some additional FAQs and links that may be helpful.

Boulder Community Health facilities for Kaiser Permanente Members:

Q: What does the agreement between BCH and KP mean for KP members?
A: In a new comprehensive facilities agreement, BCH’s Foothills Hospital becomes part of the KP hospital network for nearly all KP members.

Q: What plans are included in BCH-KP facilities contract?
A: As of March 1, 2024, KP members with the following plans have in-network access to BCH facilities:

Commercial Choice HMO
Commercial Choice PPO
Medicare Senior Advantage PPO
Medicare Senior Advantage HMO (Denver/Boulder service area only)
KP Colorado Option for Small Group

Q: What plans are not included in the contract?
A: KP Select and Medicare Advantage Northern Colorado plans are not included in the agreement and remain out of network.

Q: Are there any facilities not included in the BCH-KP agreement?
A: We are currently working to add some ancillary locations to the agreement. At this time, the following locations remain out of network.

Boulder MRI (Located at Community Medical Center in Lafayette)
Boulder Sports Medicine Imaging
Boulder Surgery Center
Foothills Surgery Center
Premier Eye Surgery

Boulder Valley Care Network for Kaiser Permanente

Q: What does the agreement between BVCN and KP mean for members?
A: The Boulder Valley Care Network is a clinically integrated network of Boulder Community Health providers and members of the Boulder Valley Independent Practice Association. KP signed a provider agreement with the BVCN that will offer more provider options for most KP members. Members of some KP plans will have access to BVCN’s network of more than 600 primary care and specialty care physicians, which includes clinicians from the BCH system.

To see a directory of BVCN doctors, advanced practice providers and advanced practice providers, search participating providers here.

This agreement also includes access to facilities across the county, such as the Della Cava Family Medical Pavilion in Boulder, Community Medical Center in Lafayette, and Erie Medical Center in Erie.

Q: What plans are included in the BVCN-KP contract?
A: As of March 1, 2024, KP members with the following plans have in-network access to providers in the BVCN:

Commercial Choice PPO
Medicare Senior Advantage PPO
Medicare Senior Advantage HMO (Denver/Boulder service area only)

Q: What plans are not included in the contract?
A: KP Select, Kaiser Commercial HMO and Medicare Advantage Northern Colorado are not included in the agreement and remain out of network

Q: Where can I find information on BVCN providers that are in network for KP members?
A: KP members looking for care options to the Doctors & Locations portion of kp.org. We always recommend that you confirm coverage for professional services for your specific Kaiser plan by calling the Member Services number listed on your insurance card.

General

Q: I would like to schedule an appointment with a Boulder Valley Care Network provider. How can I do this?
A: Coverage varies by plan. Please call to confirm coverage by calling the Member Services number on the back of your insurance card.

Kaiser Plan	Primary Care	Specialty Care
Commercial PPO	Call physician’s office directly	No referral needed. For PPO members, contact specialist directly, no referral is required. Authorization may be required. Authorizations are based on the service being requested. If authorization is required, your PCP or specialist can request one.
Commercial HMO	BVCN providers are out of network	BVCN providers are out of network
Medicare Advantage PPO	Members can call physician office directly.	No referral needed. For PPO members, contact specialist directly, no referral is required. Authorization may be required. Authorizations are based on the service being requested. If authorization is required, your PCP or specialist can request one.
Medicare Advantage HMO	Members can call physician office directly.	No referral needed. For HMO members, contact specialist directly, no referral is required. Authorization may be required. Authorizations are based on the service being requested. If authorization is required, your PCP or specialist can request one.

Q: I am not sure if the provider or facility I want to visit is in network for my KP plan. How can I find out?
A:

Medicare members:

To find a provider or facility near you:

Senior Advantage (HMO) Medicare health plan: visit kp.org/locations
Senior Advantage Choice (PPO) Medicare health plan: visit kp.org/MedicarePPO-CO
For questions or assistance in finding a provider, call 1-800-476-2167 (TTY 711). Hours are 8 a.m. to 8 p.m., 7 days a week.
To make an appointment, call the provider directly.

For non-Medicare Choice PPO health plan members:

To find a provider or facility near you:

Choice PPO health plan: visit kp.org/choiceppo-colorado
For questions or assistance in finding a provider, call 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.
To make an appointment, call the provider directly.

Helpful Links
Kaiser Plan information:

PPO Commercial = Choice PPO plans only

PPO Medicare = Senior Advantage Choice PPO

Sample card can be found by visiting https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/co/kpco-ppo-provider-manual-section-3-member-eligibility-benefits.pdf
Page 6 section 3.5.2 & 3.5.3

Medicare = Traditional HMO Medicare

Sample card can be found by visiting https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/co/kpco-provider-manual-section-3-member-eligibility-benefits-en.pdf
Page 13 section 3.5.7
HMO Medicare Advantage members must stay within their region i.e. Boulder/ Denver.