How to Get Specialty Care
Here are answers to some common questions about seeing a specialist.
How do I know if I need to see a specialist?
If you have a new health concern, the best place to start is with your primary care doctor (also called your personal physician). Primary care doctors are trained to care for a wide range of health issues. They can help you determine if you should see a specialist for evaluation or treatment.
Do I need a referral to see a specialist?
At Kaiser Permanente medical offices, you can see many specialists without a referral from your primary care doctor. Sometimes you may be asked to check with your primary care doctor first, even if your health plan does not require a referral. That’s because in certain specialties and sub-specialties, appointments slots are kept for patients with urgent needs. Your primary care doctor can help you determine the best steps for your health care.
To see specialists who contract with Kaiser Permanente (meaning they don’t practice at a Kaiser Permanente location), you will usually need a referral.
Check your health plan or call Member Services if you have questions about whether you need a referral.
I have a Medicare Advantage plan. Do I need a referral?
You can see certain specialists at Kaiser Permanente clinics without a referral from your primary care doctor or another specialist. Customer service representatives can help you find the right specialist on your plan.
If you'd like to see a specialist who does not practice at Kaiser Permanente medical offices, you will need a referral.
I am on Managed Medicaid or Basic Health. Do I need a referral?
Yes, you will need to get a referral from your Kaiser Permanente primary care provider in order to see a specialist. You will also need to be seen by either a Kaiser Permanente specialist or a specialist in Molina’s network.
If you use a specialist outside of Kaiser Permanente, please refer to Molina’s Provider Directory for the specialists in your area.
Can I choose which specialist I see at Kaiser Permanente?
Yes, you can choose which specialist you want to see, just as you can choose your personal physician. If you are seeing a specialist and for some reason aren’t comfortable or satisfied with your care, you can change specialists.
Use our Provider Directory to find specialists in your health plan, both at Kaiser Permanente clinics and those who practice at non-Kaiser Permanente locations. Also, you can see a list of Kaiser Permanente specialists on the pages for most specialties.
Is my specialty appointment covered by my health plan?
If your health plan covers primary care at Kaiser Permanente medical offices, your visit to a specialist at a Kaiser Permanente location is covered — just like it is for seeing your primary care doctor. Depending on your health plan, you may be responsible for a portion of the cost, such as a copayment, or coinsurance.
If you see a specialist who doesn’t work at a Kaiser Permanente medical offices location, your visit is covered only if your health plan includes contracted providers.
Check your health plan to see if you need a referral to a contracted specialist and if you have a copay or coinsurance. If you’re not sure about coverage, call Member Services.
How do I make an appointment with a specialist?
You can call the specialist’s clinic for an appointment. Or, if you are registered with Kaiser Permanente member website, you can sign on to our secure member site and make an appointment online with a specialist at a Kaiser Permanente location.
Use the Provider Directory to find specialists included in your health plan. If you need help finding a specialist or have questions about coverage, contact Member Services.