Transition of Care Coverage
Currently under treatment with a non-Kelsey-Seybold Provider? Complete the form no later than 30 days after the effective date of your coverage.
If you’re currently under treatment for a serious medical condition, or you’re in your second or third trimester of pregnancy with a non-Kelsey-Seybold physician, you should complete the Kelsey-Seybold Greater Houston Plan Transition of Care Request Form no later than 30 days after the effective date of your coverage to continue seeing your non-Kelsey-Seybold provider.
Your request will be reviewed for medical necessity. If approved, you will be able to continue seeing your current provider for the amount of time specified on the approval. Your care will then be transitioned into Kelsey-Seybold to establish a relationship with a Kelsey-Seybold physician. Download and print out a copy of the Transition of Care Request Form.
Completed forms should be returned no later than 30 days after the effective date of your coverage to:
The Kelsey-Seybold Greater Houston Plan
11511 Shadow Creek Parkway
Pearland, TX 77584
Attn: Kelsey UM
You will receive a letter from Kelsey-Seybold to confirm Transition of Care approval, including authorization dates and additional instructions such as where to obtain lab tests and X-rays.