Getting an Outside Referral for Therapy from Kaiser Permanente Northern California

Kaiser Permanente Northern California operates as a closed system, meaning members typically receive care from Kaiser providers. However, there are several pathways to obtain authorization for outside therapy services.

Timely Access to Care

California law (SB 221) requires health plans to provide mental health appointments within 10 business days. If Kaiser cannot meet this standard, you have grounds to request an outside referral.

Steps:

1. Call Kaiser's Behavioral Health department to request an appointment

2. Document the date you called and the earliest appointment offered

3. If the wait exceeds 10 business days, explicitly request a referral to an out-of-network provider citing timely access requirements

4. Ask for the referral request to be submitted to the Authorization Department

Request an Appointment Hold From Bay Area Therapy Group:

1. Use the contact us button on the website.

2. Call our scheduling department at 925-532-3510

Requesting a Referral Through Member Services

1. Call Kaiser Member Services at 1-800-464-4000

2. State that you need a referral to an outside mental health provider

3. Provide your clinical reason (specialized treatment need, wait times, continuity of care, etc.)

4. Request a case number and written confirmation of your request

5. Follow up within 5 business days if you haven't received a response

Filing a Grievance

If your initial request is denied:

1. File a formal grievance through Kaiser's grievance process (call Member Services or submit online through kp.org)

2. Kaiser must respond within 30 days for standard grievances

3. For urgent mental health needs, request an expedited review (72-hour response required)

Department of Managed Health Care (DMHC) Complaint

If Kaiser denies your referral and you believe the denial is inappropriate:

1. Contact the DMHC Help Center at 1-888-466-2219

2. File an Independent Medical Review (IMR) request

3. The DMHC can order Kaiser to provide or authorize care

Tips for Success

• Document everything: dates, names of representatives, reference numbers

• Be specific about why you need a particular type of provider or specialty

• If you need a specific modality (EMDR, DBT, trauma-focused therapy), emphasize that Kaiser lacks adequate providers with that specialty

• Put requests in writing when possible through kp.org secure messaging

• Request that denials be provided in writing with the specific reason