such as an earache or sore throat with fever that cannot wait for a routine visit, can be provided at any one of our Medical Offices during regular office hours. For your primary care needs,
you may call 24
hours a day, seven days a week:
Pediatrics - 338-4444
Internal Medicine - 338-4545
Family Practice - 338-4555
OB/GYN - 338-4664
If you are outside the calling area, call 1/800/632- 9700.
There may be situations when it is necessary for you to receive unauthorized urgent care outside our Service Area. Urgent care received from non-Kaiser Permanente providers is covered only when obtained outside our Service Area and only under these circumstance:
The care is required to prevent serious deterioration of your health; and
The need for care results from an unforeseen illness or injury when you are temporarily away from our Service Area; and
The care cannot be delayed until you return to our Service Area.
To obtain payment for covered out-of-area urgent care services, follow the Out-of-Plan Emergency Claims Procedure described below.
OUT-OF-PLAN EMERGENCY CLAIMS PROCEDURE FOR MEMBERS NOT ENTITLED TO MEDICARE
To obtain payment for covered Out-of-Plan Emergency Services, request claim forms by calling or writing:
Kaiser Foundation Health Plan of Colorado
P. 0. Box 372970
Denver, Colorado 80237-6970
You must send the completed claim form to us as soon as possible, but in no event later than 180 days after you receive the Out-of-Plan Emergency Services. Attach itemized bills along with receipts if you have paid the bills. Return completed claims to the address listed on the claim form. Incomplete claim forms will be returned to you. This will delay any allowed payments.
Also, you must complete and submit to us any documents that we may reasonably request for processing your claim or obtaining payment from insurance companies.
We will act upon claims within 60 days after we receive them, unless we notify you that additional time is required. In all cases, a decision will be made within 180 days after the claim is filed. If we totally or partially deny your claim, we will notify you in writing of the reasons for denial.
You may request a review of our denial of a claim by filing a written appeal with the Claims Department at the above address. You must request a review within 60 days of notification of the denial. We will provide a written decision on the review, generally within 60 days, but no later than 120 days, citing the provision in your Service Agreement on which our decision is based.