Coverage and cost
Kaiser members and outside mental health care.
Kaiser covers a large share of Hawaii residents and delivers care largely inside its own system. If you are a member wondering about care elsewhere, here is the honest version of how that works.
An integrated system, which cuts both ways.
Kaiser is both the insurer and the provider, which is genuinely an advantage when the care you need exists inside it — your records, your prescriber and your therapist are already in one system, and members who have had a good experience with Kaiser mental health care are not wrong to stay.
The same design is the constraint when you want care elsewhere. In an integrated plan, coverage for outside services generally runs through a referral or authorization process rather than free choice of provider. That is a question for Kaiser directly, and the answer depends on your plan and your clinical situation.
What we can and cannot tell you.
We are not going to guess at another organization’s authorization decisions, and we are not going to run this page as a wedge against them.
- We do not publish network status for any payer, including this one
- Whether outside care is covered for you is Kaiser's determination, not ours to promise
- Ask Kaiser directly about referral and authorization for outside behavioral health services
- Tell us what they say and we will tell you honestly whether we can serve you
One thing worth knowing regardless of plan.
Federal parity law applies broadly: a plan that covers behavioral health may not apply stricter limits to it than it applies to comparable medical and surgical care, and that covers authorization standards rather than only copays.
If getting to a mental health level of care is markedly harder than getting to a comparable medical one, you are entitled to raise that with your plan. It is true of every payer named on this site, and it is worth knowing before a first denial rather than after a third.
Questions
Straight answers.
Can I use my Kaiser plan for a program outside Kaiser?
That is Kaiser’s determination and it depends on your plan and clinical situation — generally it runs through a referral or authorization process rather than free choice of provider. Ask them directly. We are not going to tell you what another organization will approve.
Should I leave Kaiser to do this program?
That is not a decision a treatment program should be steering, and we are not going to. A plan change affects your whole household’s medical care, not just this. If the care you need is available to you inside Kaiser, use it.
What if Kaiser denies authorization for outside care?
Denials are appealable, and behavioral health denials are appealable on parity grounds specifically. Ask for the reason in writing, because the reason determines the appeal.
Ask your plan, then call us.
We will give you a straight answer about what we can do once you know what your plan will authorize.