How to Submit a Superbill to Kaiser Permanente for Therapy Reimbursement

Kaiser Out-of-Network Process

Kaiser Permanente is a closed-network HMO and generally does not cover OON mental health services except in emergency situations. Members who see an OON therapist are typically responsible for the full cost unless they have a point-of-service plan add-on. In rare cases where OON benefits exist, members must obtain prior authorization from Kaiser before attending OON sessions and submit claims with a prior-auth number attached.

Common Denial Reasons

• ✗No prior authorization obtained before the OON session
• ✗OON services not covered under member's standard HMO plan
• ✗Service available within Kaiser's in-network panel — OON not medically necessary
• ✗Claim submitted without referral documentation from a Kaiser provider

Tips for Getting Reimbursed by Kaiser

• ✓Always advise Kaiser members to call member services first — OON mental health coverage is the exception, not the rule
• ✓Clients with Kaiser who want OON therapy often need to pay fully out-of-pocket and use Superbilled for their own records
• ✓Some Kaiser members have POS (point-of-service) plans that allow limited OON access — check the plan document
• ✓Consider helping Kaiser clients appeal an OON denial using a letter of medical necessity if waitlists for in-network care are long