KelseyCare ACO Plan FAQ

No, you can schedule an appointment directly with any Kelsey-Seybold specialist at any Kelsey-Seybold location, no referrals required. Kelsey-Seybold’s doctors have expertise in more than 65 medical specialties.

As a KelseyCare Aetna Plan member, you also have access to an extensive network of credentialed, contracted specialists with a referral from your Kelsey-Seybold physician. Affiliate specialists include doctors from Texas Children’s Hospital, Baylor College of Medicine, and other highly regarded Kelsey-Seybold physician organizations.

Yes, and it covers most of the Greater Houston-Galveston area. Please click here for a full list of eligible ZIP codes.

• Direct benefit and claim questions to Aetna Member Services at the phone number shown on your member ID card.
• Call the Kelsey Concierge at 713-442-9593 or 866-578-7018, Monday – Friday, 8 a.m. to 5 p.m. Your Kelsey Concierge provides personalized assistance to answer your questions and help resolve any concerns you may have.

• Yes, you will continue to have access to Aetna’s Health Information Line. Call the member service phone number shown on your member ID card.
• As a KelseyCare Aetna Plan member, you also have access to Kelsey-Seybold’s After-Hours Nurse Hotline by calling 713-442-0427. The After-Hours Nurse Hotline is staffed by Kelsey-Seybold registered nurses who can access your secure electronic medical record and page a Kelsey-Seybold physician when needed. You can call the After-Hours Nurse Hotline after 5 p.m. on weeknights and anytime on weekends and holidays to ask questions or discuss concerns regarding symptoms or illnesses you or a family member may be experiencing.

Yes, you’ll continue to have access to the member login at Aetna.com.

Your plan providers will file claims according to the instructions on the back of your ID card.

• When you or a covered family member need to see a doctor, you have access to Aetna’s nationwide, in-network urgent care centers. Contact Aetna’s at the phone number shown on your member ID card for more information about participating urgent care clinics.
  • Nationwide CVS Minute Clinics – If you need non-urgent care while traveling outside the Greater Houston Area, you can visit any CVS Minute Clinic nationwide, as they are in-network for your convenience.
  • Follow-Up Care – Upon returning to the Greater Houston area, you can coordinate follow-up care through your Kelsey-Seybold PCP.
• Aetna’s in-network urgent care clinics are a covered benefit.
• Benefits may vary by plan. Please refer to your Summary of Benefits and Coverage (SBC) for details.
• As a KelseyCare Aetna Plan member, you have access to virtual care on weekdays, weekends, and holidays.
  • VideoVisitNOW (co-pays apply) provides on-demand care for adults (ages 18+) from 7 a.m. to 9 p.m., Monday – Friday, and 10 a.m. to 9 p.m. on weekends and holidays. You can also access on-demand Video Visits for children (0 – 17 years) from 5 p.m. to 8 p.m., Monday – Friday. Wait times average 20 minutes or less!
  • Scheduled Video Visits (co-pays apply) provide primary care and specialty care for adults 18+ and children 0 – 17 years old from 8 a.m. to 5 p.m., Monday – Friday. Video Visits for primary care only are available on Saturdays from 9 a.m. to 2 p.m.
• If you need a prescription filled while traveling outside of the Houston area, your Kelsey-Seybold physician can order the prescription for you. To refill a prescription:
  
  • Send a secure message through MyKelseyOnline or the MyKelsey App to your doctor’s office.
  • Call 713-442-0427 and ask to be connected to your physician’s nurse.
  • If you have your prescription bottle you can call the pharmacy phone number on the bottle and request that they transfer your prescription to a pharmacy close to you.

Depending on the severity of your situation:

• Go to the closest emergency room for serious and immediate medical treatment needs.
• Contact your Kelsey-Seybold physician during normal business hours.
• Call Kelsey-Seybold’s After-Hours Nurse Hotline at 713-442-0427. 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 a Kelsey-Seybold physician and have medications called into a local pharmacy, as necessary, to treat your condition.
• Seek care from one of Aetna’s nationwide, in-network urgent care centers.

• Go to the closest emergency room if you are experiencing a serious medical emergency that requires immediate medical attention. If a situation seems life-threatening, take immediate action, and call 911.
• Emergency services are a covered benefit, but may vary by plan. Contact Aetna at the phone number shown on your member ID card or refer to your Summary of Benefits and Coverage (SBC) for details.
• Emergency care services include medical, psychiatric, surgical, hospital, and related healthcare services, such as ambulance service and testing, which are required to treat a sudden, unexpected onset of 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, sudden paralysis, or slurred speech.

If you’re currently undergoing treatment for a serious medical condition and want to enroll in the KelseyCare Aetna Plan, please complete a Transition Coverage Request form or contact Aetna’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 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 Kelsey Concierge can help you. Call 713-4-Harris (713-442-7747), Monday – Friday, 8 a.m. to 5 p.m.

• Please refer to your Summary of Benefits and Coverage (SBC) for detailed information on maternity coverage.
• Take advantage of Kelsey-Seybold’s complimentary educational maternity classes and programs.
  
  • Learn more about the Kelsey-Seybold Pregnancy Portal.
  • Join a virtual breastfeeding class, available monthly at no cost.

Yes, you'll have access to Aetna’s National Urgent Care Network through your KelseyCare Aetna Plan, as well as many options for after-hours care at Kelsey-Seybold. Saturday sick-care appointments at four Kelsey-Seybold regional locations: Bay Area Campus in Webster, Fort Bend Campus in Sugar Land, Memorial Villages Campus at I-10 and Katy Freeway, and North Houston Campus off FM 1960 and Cypress Woods Medical Drive. With the KelseyCare Aetna Plan, you have many options for after-hours care, including:

• Kelsey-Seybold’s After-Hours Nurse Hotline at 713-442-0427 is available weeknights after 5 p.m. and on weekends and holidays. A Kelsey-Seybold registered nurse will answer your questions, page your Kelsey-Seybold 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: Bay Area Campus in Webster, Fort Bend Campus in Sugar Land, Memorial Villages Campus on I-10/Katy Freeway and Bunker Hill, and North Houston Campus off FM 1960 and Cypress Woods. Call our 24-hour Contact Center at 713-442-0427 after 5 p.m. on Friday or on Saturday morning for a Saturday appointment.
• Urgent care is available through Aetna at urgent care clinics nationwide. You can find an urgent care clinic near you by searching the Find a Doctor tool via Aetna’s National Urgent Care Network. Urgent care clinics treat conditions that need immediate attention but aren’t life-threatening, such as broken bones, fractures, cuts, lacerations, sprains, strains, fevers, and minor infections.

Kelsey-Seybold has specialists with expertise in more than 65 medical specialties. No referral is necessary to schedule an appointment with any Kelsey-Seybold specialist at any Kelsey-Seybold location. Go to kelsey-seybold.com/bios and search “Find a Doctor” by specialty to view biographies and Kelsey-Seybold physician videos.

When needed, your Kelsey-Seybold physicians will engage specialists on your behalf at Kelsey-Seybold and other top medical groups and hospitals to ensure a quality treatment plan to meet your specific care needs.

In addition, your KelseyCare Aetna Plan gives you access to an extensive network of affiliated specialists in the Texas Medical Center and in the community, and your Kelsey-Seybold physician will make a referral based on your needs. Affiliated specialists who work with us include doctors at the renowned Texas Children’s Hospital, Texas Heart Institute, Baylor College of Medicine, and other highly regarded Kelsey-Seybold physician organizations.

As a KelseyCare Aetna Plan member, you have access to our nationally accredited Cancer Centers, which deliver quality care from a team of medical experts that follow the most current national cancer treatment protocols. What our patients also get is highly personalized care.

Our goal is to personally guide our patients toward their triumph over cancer by delivering comprehensive, personalized care by cancer experts with access to today’s leading technology, including Varian Edge radiation technology. The Kelsey-Seybold Cancer Center at our Berthelsen Main Campus was the first in Houston to offer cancer treatment using the Varian Edge. The Varian Edge makes it possible to treat a wide range of cancers noninvasively, including cancers of the brain and spine – without anesthesia or surgery. It’s an important alternative to invasive surgery for tumors that are close to critical organs and are subject to movement in the body during radiation therapy.

Should you require care that’s not available within Kelsey-Seybold’s nationally accredited Cancer Centers and Infusion Centers, our cancer specialists will make a referral with the appropriate cancer center or treatment program that offers the best outcomes for your personal situation. This includes Baylor College of Medicine, MD Anderson Cancer Center, St. Luke’s Health, and Texas Children’s Hospital.

• With MyKelseyOnline.com and the MyKelsey App, you have a private and secure way to connect with your Kelsey-Seybold physicians and to keep track of test results, appointments, medical history, and more.
• Sign up at MyKelseyOnline.com or call 713-442-6565 for 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.
  • Make your own appointments with Kelsey-Seybold primary care physicians and an expanding list of specialists.
  • Schedule on-demand virtual care and appointments for other medical services, including flu shots and other vaccines/injections and lab services.
• Our LanguageLine interpretation service for video visits is available for all Kelsey-Seybold video visits. This feature is taking the telemedicine experience to a new level by providing on-demand interpretation for our diverse patient population within seconds. In addition to English, there are currently six languages available for Video Visits: Arabic, Mandarin, Russian, American Sign Language, Spanish, and Vietnamese. Requesting a LanguageLine interpreter is a quick and easy process.

Complete Access to Care, 24/7 – Choose the Kelsey-Seybold physician you want to see at any of our 40+ clinic and campus locations, and make an appointment with no referral required. Contact our 24/7 Contact Center for appointment scheduling. Speak to a Kelsey-Seybold registered nurse whenever you have a concern after hours – just call our After-Hours Nurse Hotline after 5 p.m. on weekdays and on weekends and holidays at 713-442-0427. Make appointments for sick care at four locations on Saturdays: our Memorial Villages Campus, Fort Bend Campus, Bay Area Campus, and North Houston Campus.

Access to Houston’s Top Hospitals– This includes facilities with Texas Children’s Hospital, St. Luke’s Health, Memorial Hermann, Houston Methodist, The Woman’s Hospital of Texas, and HCA Houston Healthcare.

All in One Place – Discover the convenience of having primary and specialty care, on-site labs, diagnostic services, and more all in one location. Plus, our regional campus locations bring outpatient surgery and nationally accredited cancer care even closer to home.

Secure Online Access to Your Kelsey-Seybold Physician– Enroll in MyKelseyOnline and download the free MyKelsey App to securely view your lab results and email your Kelsey-Seybold physician’s office with questions and follow-ups.

Your Care Team Is Connected– Your Kelsey-Seybold doctors are connected to each other and to you through your electronic health record. By working together, your care team provides the personalized care you need, plus a more streamlined healthcare experience.

Kelsey Concierge– The Kelsey Concierge is your personal connection for answers, billing help, and more! Call 713-4-Harris (713-442-7747), Monday – Friday, 8 a.m. to 5 p.m.

With the KelseyCare Aetna Plan, you’ll get quality care from leading Kelsey-Seybold physicians and premier hospital partners. You'll have a concierge level of service available exclusively for KelseyCare Aetna Plan members. When you select the KelseyCare Aetna Plan you are exclusively selecting Kelsey-Seybold physicians and Kelsey-Seybold affiliate specialists to coordinate and deliver your care and treatment. The KelseyCare Aetna Plan offers comprehensive benefits, including physician care, hospitalization, outpatient surgery and treatment, diagnostic services, and preventive care. The bottom line: Kelsey-Seybold and Aetna are the partners you want for convenient, comprehensive, quality care.

• Available 24 hours a day, seven days a week to schedule appointments.

• Speak with a Kelsey-Seybold registered nurse after 5 p.m. on weeknights and on holidays and weekends.

• Speak with a Concierge representative for help with finding nearby clinic locations and physicians and for expert help resolving your questions and concerns about your plan.

• Call 7 a.m. to 9 p.m., Sunday – Saturday, for help setting up or using your MyKelseyOnline account.