Frequently Asked Questions

• If you do not live within the service area (see below link to eligible zip codes).
• If you or your family member(s) that do not want to change providers to Kelsey-Seybold.
• If you have a family member that lives too far outside of the service area:
  • Child(ren) going to college but, lives close enough to drive into the Greater Houston Area for care:
    • Utilize KelseyCare virtual visits.
    • Blue Essentials / Kelsey-Seybold PCP Plan in-network Urgent Care.
    • Out of area members would have to travel to the greater Houston area for in-person Dr. visits.
    • Or members can choose a Blue Essentials PCP in their area (non-Kelsey-Seybold)
  • Child(ren) that live out of state:
    • See Guest Memberships below.

BCBS offers 3 types of Guest Memberships: Long-Term Traveler, Families Apart, and Student.

Long-Term Traveler:

• Length of term must be at least 90 days up to 2 yrs.
• Eligible for renewal through review.
• Typically used for long-term traveler or retiree with dual residence.
• Home HMOs may limit the number of Long-Term Traveler Guest Memberships to two per year. Home HMOs have the options of extending or renewing Long-Term Traveler Guest Memberships.

Families Apart:

• Available for qualified spouses or other dependents of the subscriber who reside outside the Home HMO service area for 90 or more consecutive days.
• To qualify for a Families Apart Guest Membership, the spouse or other dependent must not be residing with the subscriber and must be residing in the service area of another participating HMO.
• Typically used for divorced or separated families permanently residing outside of the subscriber's Home HMO service area.

Student:

• Available to qualified dependents of the subscriber, who are out of the Home HMO service area for 90 or more consecutive days attending school.
• A subscriber is not eligible for this type of Guest Membership.
• To qualify for a Student Guest Membership, the dependent must not be residing with the subscriber and must be residing in the service area of another participating HMO.
• There is no administrative time limit on the length of a Student Guest Membership.

• You may see any Kelsey-Seybold Specialist at any time, no referrals required.
• If you are diagnosed with a condition that we do not treat, we will refer to you one of our 7,800 Affiliated Providers that include, Methodist, St. Lukes, Baylor College of Medicine, Memorial, HCH and more.
• Note that on rare occasions when we have a patient that is diagnosed with a rare form of cancer we do not treat, the member may be referred to MD Anderson.
• Note children diagnosed with cancer will be referred to Tx Childrens.
• Although our PCP’s can treat basic mental health issues, you may self-refer to Blue Essentials large Behavioral Network.

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

• Yes. Call the BCBS 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 record (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.

• Your KelseyCare plan providers will file your claims with BCBS for you.

Depending on the severity of your situation:

•  Contact your Kelsey-Seybold physician during normal business hours.
• Contact the Kelsey-Seybold After-Hours Nurse Hotline, available toll free at 1-800-231-6421.
• Seek care from one of BCBS/ Blue Essentials participating Urgent Care centers available across the country. Call the phone number shown on your Member ID card for more information about participating Urgent Care facilities inside or outside of the Greater Houston area.
• Emergency care and in-network Urgent Care via BCBS/Blue Essentials is a covered benefit. Please refer to your SBC for details.
• Go to the nearest emergency room for serious and immediate medical treatment needs.
• KelseyCare Virtual Dr. Visits:
  • These are Dr. visits scheduled in advance.
  • Copays apply.
  • Adult VIDEO VISITS (18+ years):
  • Pediatric VIDEO VISITS (0-17 years):
  • 8 a.m. to 5 p.m. – Monday-Friday
• KelseyCare Virtual Visits on Demand
  •  Non-scheduled Dr. Visits (wait in que).
  • Copays apply.
  • Adults 18+ only
  • 7 a.m. to 9 p.m. – Weekdays.
  • 10 a.m. to 4 p.m. – Weekends and Holidays.

Yes.

You'll have access to BCBS/Blue Essentials in-network Urgent Care facilities. BCBS offers over 50 participating urgent care centers throughout Greater Houston area and nationally. 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. With the Blue Essentials / Kelsey-Seybold PCP 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 (Bay Area Campus), Memorial Villages Campus, North Houston Campus in the FM 1960 area, and Fort Bend Campus (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.

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. Please refer to your SBC for more detail.

NOTE: Convenience Clinics are not considered an Urgent Care facility i.e., Minute Clinic etc.

The member will pay their first initial copay, and then there will be a global bill due after delivery. Some members choose to pay as they go, so they don’t have to pay all the bill at once at delivery. For the initial deliver the newborn will be covered under the mother. Any claims after deliver the newborn will have their own deductible, copays and out of pocket maximums.

Kelsey-Seybold 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 Hospitals
• HCA Houston Healthcare Clear Lake
• HCA Houston Healthcare The Woman's Hospital of Texas
• Memorial Hermann – Memorial City

• 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 730+ Kelsey-Seybold physicians with no referral needed, plus over 7,800 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).
• Convenient on-site laboratories, X-ray and pharmacy.

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 65 specialties, with biographies and physician videos available for viewing at Kelsey-Seybold.com.

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.

In addition, Kelsey-Seybold has over 7,800 long-term relationships with high-quality affiliate providers, including CHI St. Luke's Health, Methodist and the Texas Heart Institute for cardiovascular surgery, Texas Children's Hospital and Baylor physicians for pediatric specialty care, MD Anderson and many others.

• 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 713-442-6565 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.
  • Virtual visits

Kelsey-Seybold Contact Center

• Available 24 hours a day, 7 days a week to schedule appointments.
• 713-442-0000

Kelsey-Seybold After-Hours Nurse

• Speak with a Kelsey-Seybold nurse after regular business hours, on holidays, and on weekends.
• 713-442-0000

KelseyCare Concierge Service

•  Assistance with appointment scheduling and information about participating physicians, clinic locations, and services available at each clinic.
• 713-442-9593 or 1-866-578-7018

MyKelseyOnline (MKO)

•  Help with setting up or using your MKO account 713-442-6565