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Clinical review
For information concerning whether a specific service or benefit is covered, please refer to your Evidence of Coverage, or call Kaiser Permanente Member Services toll-free at 1-800-464-4000
The documents below explain how we review requests and make decisions about care.
Please note: The Health Plan uses guidelines to decide whether to approve, modify, or deny care or services. Your care may be different based on your health needs and the benefits covered by your plan.
Please select your coverage:
Health Plan Utilization Management (PDF)
For Medi-Cal Members (PDF) click here for the List of Medi-Cal Services Requiring Pre-Approval