Frequently Asked Billing Questions

A deductible is the amount your insurance requires you to pay before they begin covering your medical expenses.

A coinsurance is your portion of your medical expenses. This amount (percent) is determined by your insurance company. ​

Many HMO plans now have coinsurance due on some services.

Example: A coinsurance may be due on a surgical procedure or hospital care.

Yes. The amounts due are determined by the insurance plan.

A contractual adjustment is the difference between the amount of the charge billed to the insurance carrier and the amount that is allowed by the insurance carrier. A contractual adjustment is applied when the amount billed is higher than the agreed allowable amount and the services are covered by the insurance company.

No. Example: If an insurance company denies a service due to maximum benefits, the contractual adjustment will not be honored.

No. We don't offer reasonable and customary adjustments to insurance companies with which we are not contracted.

Yes. Please contact the Business Office at 713-442-5500 and ask for an itemized statement for your flexible spending account. You may specify the dates of service you need. You may also use receipts provided by the Clinic or Explanation of Benefits mailed to you by your insurance company.

The front desk is only able to provide estimates of amounts due from patients. Even if we verify your benefits with your insurance company, they do not guarantee payment. After your insurance company processes your claim, a balance may still be due from you.

The Clinic provides medically necessary care to our patients. The full scope of this care cannot be determined until the patient is examined by a Physician.

We can, upon request, provide an estimate of your visit's cost. We can also provide a more detailed estimate once your doctor has prescribed medically necessary tests or procedures. You may request this estimate from the front desk before obtaining these services.

Kelsey-Seybold Clinic will make every effort possible to verify your coverage and benefits, and inform you if we learn that a service is not covered. However, we aren't always able to contact your insurance carrier before your visit. Insurance companies do not guarantee benefits; they only provide us with an estimate of the coverage available.

The physicians at Kelsey-Seybold Clinic provide the care that is medically necessary for each patient; they do not provide care based on insurance coverage. Patients are encouraged to contact their insurance company with any questions about services covered or not covered by their plan.

Due to regulatory requirements, the ASC is a separate facility from the Clinic. They may have asked you to make a prepayment based on co-pay, coinsurance, or deductible.

When a procedure is performed at a Surgery Center, several providers are involved in your care:

1. Your facility bill covers your pre-op and post-op stay, as well as nursing care, most medications and time spent in the operating room or procedure room.
2. Your physician bill covers the performance of your procedure.
3. The Anesthesiologist will bill separately for their services, if applicable. For Anesthesia service questions, please contact Medical Center Anesthesia at (713) 790-9412.
4. The pathologist will bill separately for their services, if applicable. If removal of tissue is anticipated or if you receive a bill from a Pathologist, tissue was removed during your procedure. For questions regarding pathology billing, please contact Brown and Associates at 713-559-6920.

The ASC, Emergency Room, or Hospital will bill you for the facility charges at their location. This statement/bill does not include the services provided by the Clinic's physicians.

Please see our "Guide to a Statement" for help understanding how to read your billing statement. 

Guide to a Statement (PDF)

Patients have two options to pay bills online:

• Registered patients can log on to MyKelseyOnline.
• Visit KelseyPay.com for a quick, one-time payment option.