GEORGIA
guide to HMO plans
Kaiser Permanente has the
“Highest Member Satisfaction
among Commercial Health Plans
in the South Atlantic Region,
Three Years in a Row.”¹
Fast Facts
• 29 convenient Kaiser Permanente medical facilities across metro Atlanta
and Athens.
• Primary care, specialists, lab, X-ray, and pharmacy services available under one
roof at most medical facilities.
• All caregivers in our medical facilities—primary care, specialists, nurses,
pharmacists, lab technicians —share access to members’ health records through
our electronic medical records system.
• Four of our medical facilities also provide after-hours urgent care, which includes
primary care, lab, X-ray, and pharmacy services.2
• Access to approximately 30 affiliated community After-hours Urgent Care Centers
across metro Atlanta.
•N
o additional charge for home delivery on mail-order prescription refills—
available online or by phone.2
• Members can email their doctor’s office.
•N
o claims to file when receiving care at any of our medical facilities.
•N
o referral needed to see specialists at our medical facilities.
•S
pecial rates on chiropractic, accupressure, accupuncture, and massage therapy
services, fitness club memberships, vision care, vitamins, and more.
Affiliated Metro Atlanta and Athens Hospitals
3
• Athens Regional Medical Center
• Northside Hospital—Forsyth
• Children’s Healthcare of Atlanta at Scottish Rite
• Piedmont Hospital
• Children’s Healthcare of Atlanta—Egleston
• Piedmont Fayette Hospital
• Gwinnett Medical Center—Duluth
• Piedmont Henry Hospital
• Gwinnett Medical Center—Lawrenceville
• Piedmont Mountainside Hospital
• Northside Hospital
• Piedmont Newnan Hospital
• Northside Hospital—Cherokee
• St. Joseph’s Hospital—Atlanta
1K
aiser Foundation Health Plan of Georgia, Inc. received the highest numerical
score among commercial health plans in the South Atlantic Region (GA, NC, SC)
in the proprietary J.D. Power and Associates 2010 - 2012 U.S. Member Health
Plan StudiesSM. Study based on 32,868 total member responses, measuring
nine plans in the South Atlantic Region (excludes Medicare and Medicaid).
Proprietary study results are based on experiences and perceptions of members
surveyed December 2011-January 2012. Your experiences may vary. Visit
jdpower.com.
2 If you have an emergency, call 911 or go to the nearest emergency room.
3 The hospital you are admitted to is determined by the primary care physician
you select. Some locations are available only in specific cases. In an emergency,
you have access to any hospital emergency room.
Frequently Asked
Questions
Q: Do members have to choose a personal physician?
A: Y
es. Upon enrollment in Kaiser Permanente, the first
step to receiving care is for members to choose their
own personal physician. Having a personal physician
(also referred to as a Primary Care Physician) helps
ensure our members get the coordinated care they
need and deserve.
Our industry-leading electronic health record system,
used exclusively in Kaiser Permanente medical
facilities, puts us ahead of our competitors and allows
us to offer a level of online consumer engagement
tools the vast majority of other health plans don’t
offer. Our system connects our members, doctors,
pharmacists, and lab technicians together to improve
the quality, efficiency, and effectiveness of care our
members receive.
Q: Who can be selected as a personal physician?
A: W
ith Kaiser Permanente, members can select
their personal physician from The Southeast
Permanente Medical Group physicians
(TSPMG) who practice in our medical facilities.
Our physicians are well-qualified and adhere to a
high standard of care. Many come from some of the
top medical schools and training programs in the
country, including Duke University, Emory University,
Harvard University, Johns Hopkins University, and
Yale University; 100 percent are required to be
Board Certified; and all focus on caring for Kaiser
Permanente members.
Q: Are there some services members can receive
without a referral from a personal physician?
Q: If a member has children away at school,
are they covered?
A: Yes. Members who are temporarily outside of our
service area, such as students, are covered. If a
member’s children are attending school in another
Kaiser Permanente service area, they can receive
visiting member benefits. If their children are not
in a Kaiser Permanente service area, they’re still
covered for emergency and urgent care.
They can go to any emergency room or urgent care
provider, but if they are admitted to the hospital, they
should notify us within 24 hours of their admission, or
as soon as reasonably possible.
Q: Will members have to get approval to receive care?
A: Some services require prior notification and/or
preauthorization by the Utilization Management
Program. If a member fails to obtain preauthorization,
it may result in penalties against their benefit
payment, or we may deny all or part of their claims.
In the event we deny any service because it does not
meet criteria, they may request an appeal.
Utilization Management Department
404-364-7320
1-800-221-2412
Monday through Friday from 8 a.m.-5 p.m. (EST)
Q: What if a member needs to be admitted to
the hospital?
A: Kaiser Permanente is affiliated with the Gwinnett,
Piedmont, Northside, and Children’s Healthcare of
Atlanta hospital systems. The member’s personal
physician choice will determine the hospital to
which they will be admitted.
Q: Where can members get Kaiser Permanente
prescriptions filled?
A: Y
es. To make it easy to get the care they need,
members have direct access to all specialty
departments in our medical facilities—no referral
necessary.
A: If the member’s plan has a prescription drug
benefit, they can get prescriptions filled at any
Kaiser Permanente medical facility pharmacy. Please
remember that under most benefit plans, drugs must
be prescribed by a Kaiser Permanente physician,
referral specialist, or any dentist.
Q: How much will appointments cost?
Q: Can members access their health record online?
A: T
he amount members pay for appointments will be
determined by their plan. If the plan has a copayment
or coinsurance, the copayment or a percentage of
the costs is due at the time of each visit. For more
information about specific copayments, co-insurance,
or benefits, please contact our Member Services
Department at 404-261-2590 locally or
1-888-865-5813 long distance.
A: Yes. With My Health Manager on kp.org, the
member portion of our electronic medical records
system, members being treated in our medical
facilities can view their health record online. Some of
the secure features available online allow members
to view lab results, view after-visit summaries, email
their doctor’s office, order prescription refills, and
much more. My Health Manager makes it easier for
members to stay healthy and productive.
How to Reach Us
Health Line
Medical Claims
For information, nurse advice, appointment cancellations,
or to schedule an appointment in Pediatrics/Adolescent
Medicine or Adult Medicine, call the HEALTH LINE
24 hours a day, seven days a week. To schedule all other
appointments, call Monday through Friday between
7 a.m. and 7 p.m.
Answers questions about medical bills and provides
medical claims for HMO plans.
404-365-0966 locally
1-800-611-1811 long distance
TTY: 1-800-255-0056
(Disponible en Español)
Kaiser Permanente Online
Monday-Friday: 8:30 a.m. to 5 p.m.
404-261-2825 locally
1-888-865-5813 long distance
On kp.org/myhealth, members can:4
• Email their doctor’s office
• Schedule, view, and cancel routine appointments
Member Services
Offers assistance selecting a personal physician;
explaining how your health plan works; and questions
about eligibility, and coverage verification.
Monday-Friday: 7 a.m. to 7 p.m.
• Review after-visit summaries
• View lab test results
• Order prescription refills
• Act for a family member
404-261-2590 locally
1-888-865-5813 long distance
(Disponible en Español)
• View eligibility and benefits5
• View claims and claims status5
• Monitor ongoing health conditions
Pharmacy
Members with a prescription drug benefit can have
prescriptions filled at any Kaiser Permanente medical
facility pharmacy. In addition, two great time-saving
options are available when refilling prescriptions
previously filled at a Kaiser Permanente medical facility
pharmacy: Order online at kp.org/rxrefill, or call the
24-hour Refill Line at 770-434-2008.
• Order replacement ID cards
•­And much more
4 Available to members receiving care/filling prescriptions
at a Kaiser Permanente medical facility.
5 Available to any member registered on kp.org.
brokernet.kp.org/ga
Kaiser Foundation Health Plan of Georgia
Nine Piedmont Center
3495 Piedmont Road, NE
Atlanta, GA 30305
404-364-7000
At the time of production, the information contained in this publication
was accurate. Please contact Member Services at 404-261-2590 locally
or 1-888-865-5813 for the latest information.
Please recycle.
60095880 11/12
©2012 Kaiser Foundation Health Plan of Georgia, Inc.