Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.

Kaiser Foundation Health Plan of the Mid-Atlantic States
2101 East Jefferson Street
Rockville, MD 20852
Telephone: (301) 816-2424
Fax: (301)816-7119
Member Services: (800) 777-7902
Provider Services: (877) 806-7470

Web site: kp.org

Key Staff
President: Kim Horn
Medical Director: Bernadette Loftus, MD
Provider Relations and Contracting: Cheryl Toland, Dir., Appeals & Correspondence
Government Relations: Laurie Kuiper, Sr. Director

Other Contacts
General Company Information: Scott Weier, Sr. Dir., Corporate Communications
Grievance/Appeals Procedures: Cheryl Toland, Dir., Appeals & Correspondence
Quality Improvement: Joan Gelrud, VP, Quality & Risk Management
Pharmacy Benefits: Megan Famodu, Pharmacy Benefits Mgr.

Specialized Health Care Services
Service In-House Contracted
Mental Health X
Pharmacy Benefit Mgmt.  x-MedImpact; OptumRx
Vision Care X
Dental Care  x-Dominion Dental; DentaQuest
Disease Mgmt. X
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO (Flex)
Individual X
Small Group (2-49 Employees) X  X
Large Group (50+ Employees) X  X
Administrative Services Only (ASO) X

 

Network Providers Under Contract (numbers are combined HMO/PPO)
Network Providers HMO PPO  PAR
PCPs 134  249
Physician Specialists 446  2,491
Hospitals 3  8
OB/GYNs 52  172

 

Enrollment (as of February 29, 2016:  265,669)
Standard HMO 228,091
Point-of-Service (POS) 3,448
Medicare Cost 20,876

 

Virginia HMO Service Area:
Counties
Arlington, Caroline, Culpeper, Fairfax, Fauquier, Hanover, King George, Loudoun, Louisa, Orange, Prince William, Spotsylvania, Stafford, Westmoreland

Cities
Alexandria, Fairfax City, Falls Church, Fredericksburg, Manassas, Manassas Park