Member FAQ

There are several ways to obtain your insurance card from Aetna:

1. Call Aetna CVS Health member services at 1-844-365-7373 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m. local time for assistance.
2. Go to AetnaCVSHealth.com to to set up your member profile and receive an electronic version of your insurance card.
3. Download and register on the Aetna’s app to download your insurance card.

• Call the Aetna CVS Health Member Services center for specific information about your benefits and coverage. Aetna CVS Health member service: 1-844-365-7373 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m.

If you did not actively select a primary care provider (PCP), you were assigned to a PCP at the time of enrollment. Aetna follows Texas Department of Insurance (TDI) regulations, which require Qualified Health Plans to assign PCPs through a random geographical assignment.

When Kelsey-Seybold Clinic or a Kelsey-Seybold doctor is designated as your PCP, you can see any Kelsey-Seybold primary care provider and most specialists.

• As an Aetna CVS Health plan member, all of your care is now provided and directed by Kelsey-Seybold doctors. Refer to the Aetna CVS Health website for a list of physicians specific to your plan, or go to kelsey-seybold.com to see a list of all Kelsey-Seybold physicians and locations available to you.
• When you receive care at Kelsey-Seybold, you can see any doctor, at any location.
• If you are currently receiving care from a provider not in the Aetna CVS Health network, your services will not be covered. Aetna CVS Health plans do not have an out-of-network benefit. Kelsey-Seybold offers comprehensive healthcare with more than 65 medical specialties. Kelsey-Seybold is your medical home, and your Kelsey-Seybold providers will direct your care and help you navigate the health system.
• If you are under active cancer treatment or pregnant, you may be eligible for a transition of care approval from your insurance carrier. Note, you must receive approval from your health plan to continue your care with a non-Kelsey-Seybold doctor.  Contact Aetna CVS Health member service at 1-844-365-7373 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m.

It’s easy to schedule an appointment with a Kelsey-Seybold doctor online or by phone and at your convenience.

• Schedule Online: Schedule primary care appointments and many specialty appointments through your “MyKelseyOnline” account or on the MyKelsey App. You can also self-schedule online with ANOW. Make an Appointment.
• Schedule by phone: Our 24/7 Contact Center is available to schedule primary and specialty care appointments for you and your family. Call 713-469-3490.

Yes, Kelsey-Seybold offers Virtual Visits, including Video Visits and E-visits, 7 days a week including evenings, weekends, and holidays. Virtual Care is provided by Kelsey-Seybold providers who will have access to your secure electronic medical record. You will need to be registered on MyKelseyOnline.com or download the MyKelsey app to be able to conduct a Virtual Visit with a Kelsey-Seybold provider.

Aetna CVS Health plans do not offer out-of-network benefits. If you see a provider without authorization and who is not in network, you would be responsible for the entire cost. Refer to the Aetna CVS Health website for a list of physicians specific to your plan. For the most accurate list of in-network providers, be sure to log in to your member account at AetnaCVSHealth.com and conduct your search from there.

One of the advantages of receiving your care from Kelsey-Seybold is that you can see any doctor, at any location. If you receive care from a provider not in the Aetna CVS Health network, your services will not be covered, and you will be responsible for the entire cost. With Kelsey-Seybold as your medical home, your Kelsey-Seybold doctors and clinical team can address and help you navigate all your healthcare needs.

• It’s important to establish a relationship with a Kelsey-Seybold primary care provider who will be key in helping coordinate both your primary and specialty care. For most specialty appointments, you can call Kelsey-Seybold’s 24/7 Contact Center at 713-469-3490 and schedule directly with no referral to see most Kelsey-Seybold specialists.

• You can search for providers by language spoken at Kelsey-Seybold.com or on our Find a Doctor page.

   

  

• If you need on-site translation during your in-person appointment, please be sure to inform the Contact Center when you schedule your appointment.

• If you receive care from a provider not in the Aetna CVS network, your services will not be covered, and you will be responsible for the entire cost. Kelsey-Seybold is now your medical home in your Aetna CVS Health plan, and Kelsey-Seybold doctors are ready to deliver and coordinate your healthcare needs. Your Kelsey-Seybold physician can request medical records from your current specialist as part of care coordination.
• If you are under active cancer treatment or are pregnant, you may be eligible for a transition of care approval from your insurance carrier. Note, you must receive approval from your health plan to continue your care with a non-Kelsey-Seybold doctor.
• Contact Aetna CVS Health by calling the number on your insurance card to discuss transition of care options and approval/authorization.

For your first visit, we suggest bringing:

•  A list of your current medications. Bring your prescription bottles or a written list. If you bring in a list of your medications, be sure to include the name of the medication, dosage, and the pharmacy where they were last filled.
• Previous medical records. Click here to learn more about how to transfer medical records to Kelsey-Seybold.

Emergency room services are covered in your plan. If you or a family member are experiencing a serious medical emergency, you should call 911 or go to the nearest medical facility offering emergency care. Emergency situations can be defined as a “life-threatening or limb-threatening” situation, including chest pain, difficulty breathing, shortness of breath, uncontrolled bleeding, and signs of a stroke. Learn more about the kinds of symptoms for which you should seek Emergency Care.

Seeking care in the emergency room for non-life- or limb-threating conditions can be a costly choice to you when there were other affordable options available.

View our “Know Before You Go” guide to learn what type of care to seek based on your symptoms or injuries. Download Guide

If you do receive care in the emergency room, be sure to notify your Kelsey-Seybold physician as soon as possible.

• Kelsey-Seybold offers same-day and next-day in-person and Virtual Visit appointments for adults and children. Virtual care appointments with a Kelsey-Seybold provider are available 7 days a week until 9 p.m. for adults. Virtual Visits can be scheduled on MyKelseyOnline or through our 24/7 Contact Center at 713-469-3490.

• CVS Minute Clinics provide Aetna CVS Health plan members with another option when you need same-day care for illnesses or more urgent needs, or for walk-in care. CVS Minute Clinics are a covered benefit option as a member. They offer in-person and virtual care options 7 days a week. In-person hours vary by CVS location. For information on locations, services, and hours, visit: CVS Minute Clinic.

Visit AetnaCVSHealth.com for information on urgent care facilities in network with your plan.

To ensure you can be seen in a timely manner, we always recommend scheduling an appointment first. In most instances, you can be seen the same day, and we recommend scheduling on your MyKelsey App/MKO account or by calling the Contact Center at 713-469-3490.

• Your Kelsey-Seybold doctors will direct your care to an affiliated hospital, which includes CHI St. Luke’s, Memorial Hermann and HCA Hospitals. Patients needing specialty care will be seen by Kelsey-Seybold Clinic specialists in more than 65 medical specialties.
• When you need highly specialized care, your Kelsey-Seybold doctors will coordinate that care for you. Kelsey-Seybold physicians are affiliated with thousands of quality specialists and sub-specialists in the Greater Houston area. Your Kelsey-Seybold physician will refer you to an outside affiliated specialist based on your care needs. In these situations, you will pay the same cost as if you were receiving care at Kelsey-Seybold.

• Your Kelsey-Seybold doctors will work with you to arrange your procedure at a hospital in network with your health plan. Your Kelsey-Seybold doctors will have privileges to provide the procedure at that facility. Kelsey-Seybold physicians work with CHI St. Luke’s, Memorial Hermann and HCA Healthcare facilities in the Greater Houston area.

Cancer care is delivered by Kelsey-Seybold's nationally accredited Cancer Center in coordination with the CHI St. Luke's Cancer Center. If there is something that Kelsey-Seybold cannot treat, your Kelsey-Seybold provider(s) will refer you to an affiliate provider for treatment.

Patients receive coordinated, personalized care from a team of Hematology, Oncology, infusion, and radiation specialists. The Cancer Center delivers state-of-the-art treatment for tumors of the brain, spine, lung, breast, prostate, head, neck, and more — including highly complex cancer care.

Learn more about our nationally accredited Cancer Center: kelsey1.reachlocal.net/cancercenter.

Kelsey-Seybold’s Ambulatory Surgery Centers provide safe outpatient surgical services and procedures close to home for patients.

We operate two Ambulatory Surgery Center (ASC) locations – Kelsey-Seybold Clinic’s Berthelsen Main Campus near the Texas Medical Center and our North Houston Campus (Spring Medical and Diagnostic Center) in northwest Houston. We put patient care and comfort first. New outpatient surgery centers will open in 2024 in the Memorial/Spring Branch, Fort Bend, Clear Lake/Bay Area, and Springwoods Village communities.

Our highly skilled surgical and medical staff provide the same level of quality care you’d expect during an in-patient hospital stay at a lower cost and with the benefit of going home on the same day, helping patients get back to normal life as soon as possible.

Learn more about our Ambulatory Surgery Centers: kelsey1.reachlocal.net/asc.

If you are in immediate need of a prescription refill, there are a few options for refill approvals while you set up your care with Kelsey-Seybold providers:

• Option 1: Contact your current doctor(s) and request a one-time approval for a 30-day refill.
• Option 2: Contact the pharmacy where you last filled your prescription and ask them to get a refill exception from your current provider for 30 days.
• Option 3: Visit the Aetna CVS Health Member Portal (AetnaCVS.com) for options on refills, in-network pharmacies, and more. You can also set up your member account with Aetna CVS Health for more prescription options and benefit coverage information.
• Option 4: Schedule a Video Visit or in-person visit with a Kelsey-Seybold provider who will be able to review your current medications and write a new prescription order.

• If you are transferring your records to Kelsey-Seybold, you will need to contact your current provider to release your medical records.
• You can also contact our Medical Records Department at 713-442-5700 and complete an Authorization for Release of Healthcare Information. Download 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 Clinic – Meyerland Plaza
     Attn: Medical Records Department
     560 Meyerland Plaza Mall
     Houston, TX 77096
• Authorization for Release of Healthcare Information

• You may be eligible to continue to receive medical coverage through Transition of Care or Continuity of Care. You must receive approval from your insurance carrier to continue your care with a non-Kelsey-Seybold doctor. Contact Aetna CVS Health Plan by calling the number on your insurance card to discuss transition of care options and approval/authorization.

Kelsey-Seybold Clinic is a nationally- recognized medical organization known for delivering quality care. We’re designed to make accessing and getting the care you need easy. We offer more than 850 physicians in more than 65 medical specialties, with a growing number of locations. As a Kelsey-Seybold patient, you get the advantage of our coordinated care model and so much more, including:

1. Your primary care doctors and specialists work together to manage your health and care.
2. You get more conveniences like seeing your doctor, getting lab work, and diagnostic tests all under one roof.
3. You can see any Kelsey-Seybold physician at any of Kelsey-Seybold’s locations throughout the Greater Houston area.
4. Get lab and X-ray services, advanced imaging, and an on-site pharmacy at most locations.
5. Enjoy conveniences like same-day and next-day appointments with primary care physicians.
6. Access 24/7 appointment scheduling with knowledgeable, Houston-based appointment representatives or directly schedule online.
7. Call our After-Hours Kelsey Nurse Hotline at 713-469-3490 at no added cost to speak to nurses who can help direct you to the appropriate level of care.
8. Manage your health and follow up with your doctors through MyKelseyOnline.
9. See a primary care provider on Saturdays at several regional locations.
10. Choose Virtual Visit options for adult and children seven days a week, including after-hours, weekends and on holidays.

To learn more about Kelsey-Seybold Clinic, visit Kelsey-Seybold.com

Kelsey-Seybold cares for patients throughout the Greater Houston area at 40 locations and growing! Patients can see any Kelsey-Seybold doctor at any location – your secure medical record is available to any provider in the Kelsey-Seybold system.

From Conroe to Lake Jackson, get care at a location that is convenient to you and close to home or work. Most locations offer primary and specialty care under one roof, along with lab, diagnostic imaging, pharmacy, and more!

Kelsey-Seybold also cares for patients virtually 365 days a year with Video Visit, E-visit and E-consult options that save patients time and money.

Find a location near you.