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Aetna

​​Frequently Asked Questions

Why should I choose the KelseyCare plan and Kelsey-Seybold Clinic for my medical care?

If you're interested in getting greater value, quality healthcare, and excellent customer service, you should consider joining the KelseyCare health plan. The KelseyCare plan is delivered in partnership with Kelsey-Seybold Clinic — a medical organization with a national reputation for clinical excellence and customer satisfaction.  And the KelseyCare plan is easy to use, offering lots of conveniences. You can visit any Kelsey-Seybold physician at any of Kelsey's 19 locations throughout the Greater Houston area.  You can choose from more than 400 Kelsey-Seybold physicians with no referral required and 19 premier locations offering physician care, lab and X-ray services, advanced imaging, or on-site pharmacies. Conveniences include same-day and next-day appointments with primary care physicians; 24/7 appointment scheduling with knowledgeable, Houston-based appointment representatives; the reassurance of our After-Hours Kelsey Nurse Hotline at 713-442-0000, the ability to email your doctor's office and schedule appointments online; and Saturday appointments at regional locations. To learn more about Kelsey-Seybold Clinic, visit Kelsey-Seybold.com.


Is there a specific geographic area I have to live in to join the KelseyCare Health Plan?

Yes, and it covers most of the Greater Houston-Galveston area. Specifically, the KelseyCare service area includes all ZIP codes in Harris, Fort Bend, and Montgomery counties. It also includes select ZIP codes in Galveston, Brazoria, and Chambers counties.  ZIP codes are as follows: 77301 , 77302, 77303, 77304, 77305, 77306, 77316, 77318, 77333, 77353, 77354, 77355, 77356, 77357, 77362, 77365, 77372, 77378, 77380, 77381, 77382, 77384, 77385, 77386, 77387, 77393, 77510, 77511, 77512, 77517, 77518, 77539, 77546, 77549, 77550, 77551, 77552, 77553, 77554, 77555, 77563, 77565, 77568, 77573, 77574, 77578, 77581,  77583, 77584, 77590, 77591, 77592, 77617, 77623 and 77650. View the ful​l listing of ZIP Codes in the Service Area Map


Who should I contact if I have KelseyCare medical benefits and claims questions?

You will continue to direct benefit and claim questions to the Aetna Customer Service unit at the phone number shown on your Member ID card. You will call the KelseyCare Concierge at 713-442-9593 for personalized assistance in choosing Kelsey-Seybold doctors and getting answers to all your questions about Kelsey-Seybold.


Will I continue to have access to the Aetna 24/7 Health Information Line to speak with a nurse when needed?

Yes. Call the Aetna Health Information Line at the phone number shown on your Member ID card to speak with a nurse when needed. As a KelseyCare member, you also have access to the Kelsey-Seybold 24-hour Contact Center at 713-442-0000, and the Kelsey-Seybold After-Hours Nurse Team.  The Kelsey-Seybold After-Hours Nurse Team is staffed by Kelsey-Seybold registered nurses who can access your secure Electronic Medical R​ecord (EMR) and page your Kelsey-Seybold physician when needed.  You can also call the After-Hours Nurse Hotline at any time after normal business hours to ask questions or discuss concerns regarding symptoms or illnesses you or a family member may be experiencing. 


Will I continue to have access to Aetna.com?

Yes. You have access to both Aetna.com and Kelsey-Seybold.com for information. We encourage you to continue to visit Aetna.com to access your Health Assessment, claims, explanations of benefits (EOBs), plan documents, coordination of benefits (COB) forms, and to learn about Aetna discount programs and more.  You can also access Kelsey-Seybold physician biographies and videos, MyKelseyOnline, and information about Kelsey-Seybold at Kelsey-Seybold.com.

 

Will my healthcare providers continue to file my claims with Aetna or with Kelsey-Seybold?

Your KelseyCare plan providers will file all of your claims with Aetna for you.  


What if I become ill or injured and I'm out of the Houston area?  

Emergencies are covered worldwide. Contact Aetna at the phone number shown on your Member ID card for more information about participating Urgent Care centers outside of the Greater Houston area. After receiving care, you must notify your Kelsey-Seybold doctor as soon as possible. Please note that in the KelseyCare plan, when you are traveling out of the area, appointments with a doctor in the doctor's office are not covered without prior authorization from Kelsey-Seybold. ​Emergency care and urgent care at in-network Urgent C​are centers is a covered benefit.


What if I am currently under treatment with a non-participating physician at the time I switch to the KelseyCare Plan?

If you are currently undergoing treatment for a serious medical condition and want to enroll in the KelseyCare plan, please complete a Transition of Care form or contact your insurance company's Customer Service Line at the phone number shown on your Member ID card. Your request will be reviewed for medical necessity. If approved, you will be able to continue seeing the current provider for the amount of time specified on the approval. You will then be transitioned into Kelsey-Seybold to establish a relationship with a Kelsey-Seybold Physician. If your request is not approved, you will need to begin receiving care from a Kelsey Seybold physician. The KelseyCare Concierge can help you. Call 713-442-9593


Do I have access to Urgent Care clinics?

You'll have access to Aetna's Urgent Care Network through KelseyCare, as well as Saturday sick-care appointments at four Kelsey-Seybold locations. With the KelseyCare plan, you have many options for after-hours care, including:

  • The Kelsey-Seybold After-Hours Nurse Hotline at 713-442-0000, available weekdays after 5 p.m., on weekends, and on holidays. A Kelsey-Seybold After-Hours registered nurse will answer your questions, page your physician if necessary, and schedule needed appointments. If a situation appears life threatening, take immediate action and call 911.
  • Saturday Sick-Care Appointments for children and adults are available from 9 a.m. to 2 p.m. at four Kelsey-Seybold locations: Clear Lake Clinic, Tanglewood Clinic near the Galleria, Spring Medical and Diagnostic Center in the FM 1960 area, and Fort Bend Medical and Diagnostic Center in Sugar Land. Call our 24-hour Contact Center at 713-442-0000 after 5 p.m. on Friday or on Saturday morning for a Saturday appointment.
  • Urgent Care is available through Aetna at over 50 participating Urgent Care Centers throughout Greater Houston. Please see the attached list of Urgent Care facilities in the Greater Houston area that are available to you. Urgent Care Centers treat conditions that need immediate attention, but are not life-threatening, like broken bones, fractures, cuts, lacerations, sprains and strains, fevers, and minor infections.
  • Emergency Room (ER) Services are available when you believe you or a family member may be experiencing a life-threatening medical situation. Emergency care services include medical, psychiatric, surgical, hospital, and related healthcare services and testing, such as ambulance service, which are required to treat a sudden, unexpected onset of a bodily injury or serious sickness. Examples of emergency situations include uncontrolled bleeding, seizures or loss of consciousness, shortness of breath, chest pains or severe squeezing sensations in the chest, suspected overdose of medication or poisoning, and sudden paralysis or slurred speech.


If I am traveling outside of Houston and become ill or suffer an accidental injury, what should I do if I am enrolled in the KelseyCare plan?

Depending on the severity of your situation, you should: (1) contact your Kelsey-Seybold physician during normal business hours, or (2) contact the Kelsey-Seybold After-Hours Nurse Hotline, available toll free at 1-800-231-6421, (3) seek care from one of the participating Urgent Care centers available across the country, or (4) go to the nearest emergency room for serious and immediate medical treatment needs. Kelsey-Seybold After-Hours registered nurses have access to your Kelsey-Seybold Electronic Medical Record and can counsel you on appropriate care and next steps. The nurse can page your physician and have medications called into a local pharmacy, as necessary, to treat your condition. 

How do I find out which hospitals are in the KelseyCare Plan network?

KelseyCare physicians use partner hospitals in the Texas Medical Center and surrounding communities. A partial list of our hospital network includes:  

  • CHI St. Luke's Health—Baylor St. Luke's Medical Center, Texas Medical Center, Sugar Land,  The Woodlands, and The Vintage.
  • Texas Children's Hospital — Texas Medical Center and Texas Children's — West Campus
  • Houston Methodist — Sugar Land and Houston Methodist-Willowbrook
  • HCA Clear Lake Regional Medical Center
  • HCA The Woman's Hospital of Texas
  • Memorial Hermann — Memorial City 
  • Kindred Hospital — Medical Center
  • Select Specialty Hospital

 

What additional services does my KelseyCare Plan offer?

  • Comprehensive medical care delivered by Kelsey-Seybold physicians and affiliated physicians located throughout the Greater Houston area.
  • 24/7 appointment scheduling — Call the Kelsey-Seybold Contact Center at 713-442-0000.
  • KelseyCare Concierge — Call the KelseyCare Concierge, your personal healthcare VIP service, at 713-442-9593 or toll-free at 866-578-7018, Monday – Friday from 8 a.m. to 5 p.m.
  • Access to over 400 Kelsey-Seybold physicians with no referral needed, plus over 4,000 affiliated physicians and allied health professionals available by referral from your Kelsey-Seybold primary care or specialist physicians.
  • Same-day and next-day primary care physician appointments (Family Medicine, Internal Medicine, and Pediatrics).
  • On-site laboratories and X-ray.
  • Plus, you'll get around-the-clock services and Saturday appointments for sick care at four Kelsey-Seybold locations:
    • Tanglewood Clinic at 1111 Augusta Dr., Houston TX 77057
    • Clear Lake Clinic at 1010 South Ponds Dr., Houston TX 77598
    • Spring Medical and Diagnostic Center at 15655 Cypress Woods Medical Dr., Suite 100, Houston TX 77014
    • Fort Bend Medical and Diagnostic Center at 1155 University Blvd., Sugar Land TX 77478
  • After-Hours Nurse Hotline with Kelsey-Seybold registered nurses. Call 713-442-0000.
  • Email your doctor's office with questions using our secure password-protective service, MyKelseyOnline.
  • Easy prescription refills at pharmacies located at 15 Kelsey-Seybold Clinic locations.
  • Digital diagnostics and high-tech imaging at many locations.
  • No referrals are necessary to see Kelsey-Seybold specialists. Kelsey-Seybold specialists offer expertise in more than 50 medical specialties.


What happens if I am diagnosed with a serious illness or need surgery as a KelseyCare member?

Your Kelsey-Seybold physicians will deliver and coordinate your care and treatment, and engage specialists on your behalf, both at Kelsey-Seybold and at other top medical groups and hospitals, to ensure a quality treatment plan to meet your specific care needs. Kelsey-Seybold offers high-quality specialists available in more than 50 specialties, with biographies and physician videos available for viewing at Kelsey-Seybold.com. You can see Kelsey specialists with no referral — just call and schedule an appointment at 713-442-0000. In addition, Kelsey-Seybold has long-term relationships with high-quality affiliated providers, including CHI St. Luke's Health and the Texas Heart Institute for cardiovascular surgery, Texas Children's Hospital and Baylor physicians for pediatric specialty care, and many others. Kelsey-Seybold runs the nationally accredited, state-of-the-art Kelsey-Seybold Cancer Center and may refer patients to other nationally accredited cancer centers and hospitals based on individual patient needs and treatment. Please go to Kelsey-Seybold.com/CancerCenter to view the Kelsey-Seybold Cancer Center video and website.    


How can I communicate with Kelsey-Seybold online?

MyKelseyOnline is a private and secure way to connect with your Kelsey-Seybold physician. To communicate via the web, sign up at MyKelseyOnline.com or call 713-442-656for help with setting up or using your account. With MyKelseyOnline.com, you can:

  • Email your doctor's office
  • Request prescription refills at your Kelsey Pharmacy
  • View most test results, and
  • Make your own appointments with Kelsey-Seybold primary care physicians and an expanding list of specialists, including OB/GYN, Endocrinology, and Rheumatology.

 

IMPORTANT CONTACTS

Contact Services Number
Kelsey-Seybold Contact CenterAvailable 24 hours a day, 7 days a week to schedule appointments713-442-0000
Kelsey-Seybold After-Hours NurseSpeak with a Kelsey-Seybold nurse after regular business hours, on holidays, and weekends. 713-442-0000
KelseyCare Concierge ServiceAssistance with appointment scheduling, information about participating physicians, clinic locations,​ and services available at each clinic713-442-9593 or
1-866-578-7018
MyKelseyOnline (MKO)Help with setting up or using your MKO account713-442-6565


Why should I, as an employer, offer the KelseyCare plan?

KelseyCare is the proven, affordable option. Check out these case studies and testimonials by our employer partners. Our plan is always offered as a choice of menu options alongside PPO, POS, and HMO plans. Offer the affordable choice — available through Cigna, UnitedHealthcare and Aetna. You can be sure of enrollee satisfaction. Check out these member testimonials and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, where members vote their satisfaction level with their plan.


What are my employees going to receive from the KelseyCare plan that's different from what they get today from Kelsey-Seybold?

You still get the same great quality and service you've always known from Kelsey-Seybold, plus a whole lot more:

  • Exclusive KelseyCare Concierge. 
  • Complete care coordination by Kelsey-Seybold physicians.
  • Integrated disease management and case management.
  • Dedicated Kelsey-Seybold account manager to expedite any issues and work directly with you and your HR team.
  • Access to Kelsey-Seybold's partner hospitals, including:
    • CHI St. Luke's Health — Baylor St. Luke's Medical Center, Texas Medical Center, Sugar Land, and The Woodlands. 
    • Texas Children's Hospital — Texas Medical Center and Texas Children's — West Campus.
    • Houston Methodist — Sugar Land and Houston Methodist – Willowbrook. 
    • HCA Clear Lake Regional Medical Center.
    • HCA The Woman's Hospital of Texas.
    • Memorial Hermann — Memorial City. 


What about my employees who don't live in the Houston area?

Under the KelseyCare plan, members who live outside of the Houston area have Guest Privileges. Those employees would have access to all your other plan options. Having an NCQA-accredited ACO like Kelsey-Seybold provides a unique opportunity for you to partner for better savings, better quality,​ and better enrollee satisfaction. Include KelseyCare as an ACO-based solution for Houston.   


Do I have to give up my existing plans to offer this?

No. KelseyCare is offered alongside other plan options for greater access and choice for your employees.


Who offers the KelseyCare plan?

We deliver long-term solutions for a successful employee benefits package through these great partners:

Let one of our experienced representatives show you how these large employers are experiencing savings along with membership growth by adding the KelseyCare plan to their menu of plan offerings:

  • City of Houston
  • City of Sugar Land
  • City of Pearland
  • Shell
  • Mitsubishi Caterpillar Forklift America
  • Exterran Energy
  • Lawler Foods

Contact us t​oday.​