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

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
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 Associate Exec. Director of the Mid-Atlantic Permanente Medical Group
Provider Relations and Contracting: Cheryl Toland, Dir., Appeals &  Network Service Administration
Government Relations: Laurie Kuiper, Sr. Director, Gov’t. Relations

Other Contacts
General Company Information: Scott Weier, Sr. Dir., Corporate Communications
Grievance/Appeals Procedures: Cheryl Toland, Dir., Appeals & Network Service Administration
Quality Improvement: Joan Gelrud, VP, Quality, Regulatory, and Risk
Pharmacy Benefits: Megan Famodu, Pharmacy Benefits Manager Provider Contracting: Steven Gulla, Dir., Provider Facility Contracting

Specialized Health Care Services
Service In-House Contracted
Mental Health X
Pharmacy Benefit Mgmt.  x-MedImpact; OptumRx
Vision Care X
Dental Care  x-Dominion National
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 152  252
Physician Specialists 332  2,606
Hospitals 3  8
OB/GYNs 57  145

 

Enrollment (as of February 28, 2017:  263,138)
Standard HMO 221,293
Point-of-Service (POS) 4,135
Medicare Cost 22,375

 

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

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