You have determined that you have a problem that requires therapy. You have gone to Kaiser and they have referred you to their groups for anxiety and depression, and sent you to an in-house therapist who saw you for 4 sessions and then scheduled you to return once a month. This is not enough to meet your needs, and you would like to be approved to see an out-of-network therapist who can see you more frequently. What do you do now?
The first step is to request your records from Kaiser so that you can see what diagnoses you have been given. Kaiser will email you your records. Look to see if you have been given one of the parity diagnoses. If so, this is the key to getting appropriate treatment approved. If you do not have one of these diagnoses, does your problem relate to trauma? Is it impacting your ability to work or participate in school? How is your problem functionally affecting your life? Knowing these things will help you to demonstrate the need for you to go outside of the Kaiser internal system for treatment.
There are two types of referrals to outside providers that Kaiser provides. One is to the Beacon Healthcare System, and the other is to providers who have directly contracted with Kaiser to see Kaiser patients. These clinicians are called Kaiser Affiliates.
I will not be addressing Beacon contracted therapists as I am not a Beacon contracted provider. I can, however, address Affiliates. As Affiliates, we give Kaiser direct access to our schedules so that they can book appointments for Kaiser patients. The benefit of this system is that Kaiser is able to schedule appointments as soon as they are available.
To get a referral to a Kaiser Affiliate, we recommend that you set up an appointment a week in advance with a Kaiser Affiliate and ask them to put a hold on the Tridium account with your name on it. Ask for the Affiliate’s NPI number at this time. You will need to give the Affiliate your Kaiser number, date of birth, and full name. The Affiliate can hold the appointment time for you.
Next, you will need to contact the Kaiser referral department at (844) 359-5661 and let them know that you have an appointment with a Kaiser Affiliate. Give them the Affiliate’s NPI number and the date and time of the appointment held in Tridium. If you know your diagnosis and it is a Parity diagnosis let them know this as well. If you have gone through Kaiser’s group treatments and it has not been successful be sure to mention that. If you have seen a Kaiser therapist and found that appointments were not frequent enough to be helpful, put that out there as well. Basically, give the referral department as much evidence as possible that you meet the criteria for weekly therapy.
Kaiser will then set up an appointment with an intake specialist, who will meet with you and refer you to groups and an Affiliate.
If your Affiliate works for my group the clinician will be notified by Kaiser that you have an appointment, and the clinician will contact you by phone to confirm it. You will receive a link to the client portal and a confirmation of your appointment. Fill out your paperwork and a link will be sent to you by your clinician at the time of your teletherapy session. This description is specific to our practice but if you are setting up an appointment with another Kaiser Affiliate the steps are the same. Some therapists do not use client portals to complete paperwork and some therapists are seeing clients face-to-face for in-office visits. The clinician you choose to see will determine any differences in the procedure.
We hope that this information is getting you access to the treatment you deserve and are entitled to by law.