If your coverage is a Kaiser HMO, read this before you call anyone.
An HMO pays for care delivered inside its own system. Emergency care is the usual exception. Shift sits outside that system, so a Kaiser HMO most likely will not pay for our program. We would rather say that on this page than after you have told us your story.
Shift is out of network, and on an HMO that usually settles it.
We are not part of any commercial carrier network. On a PPO that is a cost question we can answer with a benefits check. On an HMO it is usually a yes or no question, and usually it is no. We will still read your plan if you want us to, and we will tell you what it says either way.
What we can say about your plan before we read it.
Covered by many PPO plans. We check your benefits first.
We do not waive cost shares, we do not tell you a number we have not verified, and we do not promise a result. We read your plan, we tell you what it pays toward intensive outpatient care, and you decide after that.
What your plan sets, and what we do about it.
The numbers are not on this page on purpose. Yours are specific to your plan and your plan year, and we pull them with you.
What your plan document sets
- An allowed amount for each kind of visit or day of care.
- A deductible you meet before the plan starts paying its share.
- A coinsurance split that applies after the deductible.
- An out-of-pocket maximum for the plan year.
- An authorization step for intensive outpatient care.
What we do
- Call the behavioral health number on the back of your card and pull the out-of-network figures for the level of care you need.
- Turn those figures into the dollar cost of a week of treatment and give you that number in writing.
- Open the authorization and stay on the case through review and renewal.
- Bill the plan directly, so you are not fronting the claim and chasing a reimbursement.
What can change the answer.
None of these is a promise about your plan. They are the things we look at when someone with a Kaiser card asks whether there is a path, and each of them is something you can check yourself today.
Many employers offer more than one
If your employer also offers a PPO and the next open enrollment is close, the out-of-network path may be open to you then. Tell us the timing and we will tell you what it changes.
Check your benefits A second coverageA spouse or parent plan
If you are also covered on someone else's PPO, that plan may have an out-of-network behavioral health benefit. We read whichever plan gives you a real option.
Check your benefits Access and timelinessWhat a plan owes you when it cannot deliver
California sets access standards a plan has to meet for behavioral health care. What happens when a plan cannot meet them is written up on our out-of-network page, with the steps in order.
When your plan has no out-of-network benefitKaiser, answered plainly.
Can I use my Kaiser HMO at Shift?
Most likely not. An HMO pays for care inside its own network, with emergency care as the usual exception, and Shift is outside it. If your plan is a PPO or an out-of-area option rather than the HMO, the answer can be different, and that is worth a two-minute call.
Should I call you anyway?
Yes, if you want a straight answer and somewhere to start. We will read what you have, tell you whether there is a path, and if there is not, point you at the Kaiser behavioral health line on your own card and at your county's public program. We do not get paid for that and we do it anyway.
Can I pay privately instead?
Some people do. We will tell you the private rate before anything starts, and we will also tell you honestly whether the level of care we offer is the right one for you. If it is not, we say so.
What should I do right now if this is urgent?
If anyone is in immediate danger, call or text 988, or call 911. For anything less urgent than that, call the behavioral health number on the back of your Kaiser card, and call us at (646) 275-2111 if you want a second opinion on what you are being told.
Call and we will tell you whether there is a path.
A short call. No story required before we answer the coverage question. If a Kaiser HMO is your only coverage we will say so and point you somewhere useful, which is a better outcome than a benefits check that goes nowhere.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service.
Not the card you hold.
Shift also publishes a page for Aetna, Cigna, Anthem and Elevance, Blue Shield of California, UnitedHealthcare, UMR, Carelon, Magellan and union and Taft-Hartley funds.
Background reading: how out-of-network works, out-of-network for IOP and PHP in plain English, and the program itself.