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Blue Cross Blue Shield

​Frequently Asked Questions

Can I continue to see my Kelsey-Seybold physicians after October 1, 2016?

Kelsey-Seybold physicians are no longer in-network providers for BCBS PPO/POS and Traditional/PAR Plan health plans. This termination includes out of state Blue Cross Blue Shield plans. Our patients can continue coming to us using their out-of-network benefits or other resources that they have available. Kelsey-Seybold stands ready to care for our patients as we always have.

What if I am undergoing active treatment for a medical condition?

Patients undergoing active treatment for a medical condition – for example, patients who are pregnant, undergoing chemotherapy or in the post-operative period – may be approved for Transition of Care Coverage by Blue Cross Blue Shield. This means the patient will receive his or her ongoing care for a particular medical condition at the in-network level of coverage.
Transition of Care Coverage decisions are made and approved by BCBS. Please contact their member services to learn more about how to apply for transition of care coverage.
Blue Cross Blue Shield of Texas Member Services:
(888) 697-0683
Monday -Friday
Blue Cross Continued Care Eligibility:
  • Existing pregnancy in the 2nd or 3rd trimester or high risk pregnancy
  • Members currently under the care of an oncologist and receiving a course of chemotherapy or radiation therapy
  • Members who have a terminal illness with a prognosis of six (6) months or less to live;
  • Active course of treatment; *Confinement to the hospital on the effective date of the provider's termination
  • Transplant candidates
  • Patients receiving allergy treatment
  • Rehabilitation, sub-acute, or skilled nursing facilities admissions

How do I know what BCBS plan I have?

Please call the BCBS Member Services number on your ID card.

I have Blue Cross Blue Shield as my secondary insurance, does this mean I can no longer access Kelsey-Seybold in-network?

Kelsey-Seybold patients who have Blue Cross Blue Shield as their secondary insurance coverage are not affected by the BCBS termination.  Whatever your primary payor is i.e., KelseyCare Advantage, Cigna, United Healthcare, etc., as long as you are in-network with the primary insurance you can continue to receive care from Kelsey-Seybold. We will file claims with your secondary insurance, as applicable. ​

I am a KelseyCare Advantage member, but have Blue Cross Blue Shield as my secondary insurance. What does this mean to me?

KelseyCare Advantage members who have Blue Cross Blue Shield as their secondary insurance coverage will not be impacted by the termination.  Because KelseyCare Advantage is your primary insurance you can continue to receive care from Kelsey-Seybold with no changes to your benefits. We will file claims with your secondary insurance, as applicable. ​

I’m a Federal Employee receiving benefits from Blue Cross Blue Shield, what are my options? 

During the 2018 open season enrollment period from Nov. 13 - Dec. 11, 2017, Federal Employees who are impacted by BCBS’s termination of Kelsey-Seybold Medical Group from the BCBS PPO plans may opt to select another plan that includes Kelsey-Seybold Clinic and resume their in network coverage for Kelsey-Seybold services effective Jan. 1, 2018. Go to​ from more information.

How can I get a copy of my medical record?

If you are transferring your care from a Kelsey-Seybold physician to another physician/provider in the community, that physician/provider can request a transfer of your medical record at no charge.
Optionally, you can call our Medical Records Department at 713-442-5700 and complete an Authorization for Release of Healthcare Information. You may also download a copy of the form here​.​
When you complete and sign the form and return it to Kelsey-Seybold, you authorize the release of your medical records to the community care provider of your choice. You may return the form in two ways:
  1.  By faxing it to 713-442-5732.
  2.  By mailing it to Kelsey-Seybold – Meyerland, Release of Information Dept, 560 Meyerland Plaza Mall, Houston, TX 77096

What insurance plans does Kelsey-Seybold accept?

Kelsey-Seybold Clinic accepts all other major health insurance plans, including Cigna, UnitedHealthcare and Humana. For the most up-to-date list of health insurance plans accepted, go to

Why did BCBS terminate Kelsey-Seybold from participating in its health plans?

While we cannot address decisions made by another organization, we can tell you that Kelsey-Seybold received notice of termination and was dismissed from the PPO/POS and Traditional/PAR Plan networks. It appears that BCBS exercised a contractual provision of its agreement with Kelsey-Seybold Clinic which permits one party to terminate the agreement without cause with 90 days advance notice. BCBS has made the decision to terminate Kelsey-Seybold Clinic’s participation in all PPO and POS products offered by BCBS in accordance with that provision.

Will negotiations with BCBS continue?

BCBS’s action to terminate and dismiss us from their PPO/POS and Traditional/PAR Plan network represents the final step in those negotiations. We remain open to negotiating with Blue Cross and hope one day to come to an agreement that is mutually pleasing and in the best interest of our patients. Kelsey-Seybold Clinic greatly values the trust our patients place in us. Patients are welcome to continue their care at Kelsey-Seybold Clinic by using their out-of-network benefit options, if applicable to their plan - and we will extend a 40% discount. If patients prefer to self-pay for services at the time they are rendered, we will extend a 35% discount.

Am I being dismissed as a Kelsey-Seybold Clinic patient?

No, your insurance is no longer contracted, but you are still a Kelsey-Seybold Clinic patient.  

If I use my Out-of-Network Benefits, who will file my claims with Blue Cross?

Kelsey-Seybold will continue to file your claim to Blue Cross Blue Shield.

Can you explain how the 40% o​ff discount works when combined with out-of-network charges?

Kelsey-Seybold is extending a 40% discount to our patients that are impacted by Blue Cross Blue Shield’s termination of our contract and dismissal from their network.​ Below is an example of how the discount would be applied. Kelsey-Seybold will continue to file claims on your behalf to Blue Cross as an added courtesy for our patients.
Kelsey Billed Charge:       $185.00
C​ourtesy Discount 40%: -$ 74.00
Amount Due to KSC         $111.00
BCBS Payment:                -$ 64.75 (Note: This amount will vary from $0 to some percentage based on the fee-schedule of your plan and out-of-network benefits.)
Patient Balance:             $ 46.25

What if I don’t have out-of-network benefits or prefer to self-pay? 

All patients are welcome to self-pay. We offer a 35% self-pay discount on all services and charges for patients who do not use their insurance.
If I do not agree with the amount paid by Blue Cross Blue Shield when using out-of-network benefits, who will be responsible for working the payment out with BCBS?
You or the insured will need to work with BCBS on payment issues. 

What can I do to access Kelsey-Seybold again using in-network benefits?

We understand that this situation has created a lot of stress and upset many patients and we absolutely want to continue to care for our patients. At this time, the best option if you wish to continue to access Kelsey-Seybold using in-network benefits would be:
  1. At open enrollment, look for an option to select a plan with another insurance carrier we are in-network with, such as Cigna or UnitedHealthcare. 
  2. Talk to your company about adding a KelseyCare Accountable Care Health Plan to their menu of benefit options.  We offer these plans for small and large employers – 2 employees and up.  We offer KelseyCare on many carrier platforms including Cigna, Aetna, UnitedHealthcare as well as through a third party administrator, Boon-​Chapman.