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Health Insurance Plan Information Applies To The Following Locations:
Texas Childrens Hospital Locations
- Texas Childrens Hospital
- Texas Childrens Pavilion for Women
- Texas Childrens Hospital West Campus
- Texas Childrens Hospital The Woodlands
Texas Children’s Health Center Locations
- Texas Children’s Health Center – Sugar Land
- Texas Children’s Health Center – Cy-Fair
- Texas Children’s Health Center – Clear Lake
- Texas Children’s Specialty Care – Upper Kirby
- Texas Children’s Specialty Care – Kingwood Glen
- Texas Children’s Pavilion for Women Pearland
Community Maternal Fetal Medicine Clinic Locations
- Community Maternal Fetal Medicine Clinic – The Woodlands
- Community Maternal Fetal Medicine Clinic – Northwest Houston
- Community Maternal Fetal Medicine Clinic – West Houston
- Community Maternal Fetal Medicine Clinic – Sugar Land
- Community Maternal Fetal Medicine Clinic – Baytown
- Community Maternal Fetal Medicine Clinic The Methodist Hospital
Below is a list of payers who are contracted with Texas Childrens Hospital, Texas Childrens Physician Service Organization, and Texas Childrens Anesthesiology. Please confirm Texas Childrens participation with your health plan as some benefit plans utilize narrow networks which may exclude Texas Childrens.
Facility-based physicians bill and collect independently for their services, and may not participate in the same insurance plans as Texas Childrens Hospital. You may receive a bill from a facility-based physician for the amount unpaid by your insurance plan.
Aetna
What Is Houston Methodist Hospital Known For
These days, Houston Methodist not only is well established as a leader in heart and vascular treatments, research and education based on DeBakeys achievements and reputation, but also is known for spearheading breakthroughs in organ transplantation, orthopedics, cancer treatment and neurology and neuroscience.
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Kelseycare Advantage Once Again Earns Highest
KelseyCare Advantage is one of three Medicare Advantage plans in the nation to have achieved a 5-star rating by Medicare for six consecutive years or more.
HOUSTON, October 18, 2021—-The Centers for Medicare and Medicaid Services has again rated KelseyCare Advantage as one of the nations highest-quality Medicare Advantage plans. For the sixth consecutive year, KelseyCare Advantage has achieved an overall rating of 5 out of 5 stars as part of CMS annual assessment of 471 eligible Medicare Advantage plans measured across the nation.
KelseyCare Advantage is one of only three Medicare Advantage plans in the United States with the distinction of achieving the CMS 5-star rating for at least six years in a row. Kaiser Permanente and Tufts Health Plans have also achieved national recognition as Medicare Advantage plans achieving the quality metric for six years consecutively. In addition, KelseyCare Advantage is the only plan in the State of Texas to earn “5 stars for six consecutive years.” Of all eligible plans across the United States, only 15 percent rated by CMS were rated as 5-star plans for 2022.
Superior Quality and Member Satisfaction Earn 5-Star Ratings
Enrolling in KelseyCare Advantage 5-Star-Rated Medicare Advantage Plan
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Contacts
What Do I Need To Do And When
First, know that you are not alone. We are here to provide objective guidance to support your decision.
When You Turn 64
Get information about the Medicare Advantage plans contracted with Kelsey-Seybold Clinic. Start considering doctor access, coverage, and budget requirements that are important to you and your future.
Every situation is unique. Call our team so we can understand your coverage needs and offer objective advice based on your unique situation.
3 Months Before Your 65th Birthday
You are now eligible to apply for Medicare benefits, including enrollment in a contracted Medicare Advantage plan.
If you will continue to work after age 65 and will retain your employer-sponsored coverage, call us to let us know what coverage you will use after you turn 65.
1-2 Months Prior to Your 65th Birthday
No matter what type of plan you’re considering, our team is here to help.
Month You Turn 65 & Up to 3 Months After
Be sure you receive your coverage cards and that they properly reflect your plan selection.
If you applied for Original Medicare and discovered that your Kelsey-Seybold Clinic providers are not covered, you still have time to enroll in a contracted Medicare Advantage plan.
4 Months After Turning 65
Your initial enrollment window has closed for all plans.
Your next opportunity will be during the annual enrollment period, which occurs each year from October 15 – December 7.
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What Else Should I Know About Medicare Advantage Plans
Information about Medicare Advantage Plans provided by Medicare & You 2016. Visit Medicare.gov to learn more.
Kelsey-Seybold Accepts the Following Medicare Advantage Plans*
* Kelsey-Seybold Clinic does NOT accept Original Medicare. Medicare Advantage plan access is based on county of residence. Please call 713.422.7526 to learn more.
** Existing members only.
What Happens if I Continue Working?
If you plan to continue working full-time after age 65,
you may be able to continue accessing medical services from Kelsey-Seybold Clinic using your employer-sponsored medical plan.
Please call 713.442.7526 to confirm.
If you will NOT have employer medical coverage after age 65,
you will need to contact our team to learn how to keep your Kelsey-Seybold Clinic doctors.
If you lose your employer-sponsored medical coverage,
you typically have an 8-month window in which you must enroll in a Medicare or Medicare Advantage plan to avoid paying a late enrollment penalty. Contact our team for more information.
Let Our Team Guide You On This Journey
Monday – Friday, 8:00 am – 5:00 pm
Kelsey-Seybold Clinic is not a Medicare Advantage plan. Please understand that it is your decision whether or not to join a Medicare Advantage plan. You do not have to enroll in a Medicare Advantage plan. You can always go to another provider who provides services through Original Medicare.
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Aetna Signs New Contract With Kelsey
HOUSTON, Texas Aetna announced today that it has signed a new contract with Kelsey-Seybold Medical Group, one of the largest physician-owned multispecialty group practice in the Greater Houston area. The new contract, which takes effect on July 1, returns Kelsey-Seybold to Aetnas broad network.
Aetna commercial members enrolled in a standard PPO, POS Choice II and EPO health plan who receive care from Kelsey-Seybold will be covered at the in-network level of benefits and will have access to 227 primary care physicians and 235 specialists at 19 clinic locations and a Sleep Center in the Houston area.
This agreement is good news for our members in the Houston area, said Michael Nelson, president of Aetna in Texas. We developed a value-based care insurance product anchored by Kelsey-Seybold in 2016 and we look forward to building upon our successes and strengthening our relationship with Kelsey-Seybold, while offering our members expanded access to their high-quality physicians and facilities.
Kelsey-Seybold Clinic delivers care to 500,000 patients in the Greater Houston area. Aetna provides health benefits to more than 2.3 million Commercial members in Texas.
Kelseycare Advantage Medicare Hmo Discontinuation
As of January 1, 2021, the Employees Retirement System of Texas no longer offers the KelseyCare Advantage Medicare health maintenance organization to Medicare-enrolled participants through the Texas Employees Group Benefits Program . Medicare-enrolled retirees, survivors and dependents who were in KelseyCare Advantage can continue their health coverage through the GBP in one of two high-quality health plans.IMPORTANT NOTICE ABOUT INSURANCE: Health and other insurance benefits for employees and retirees are subject to change based on available state funding. The Texas Legislature determines the level of funding for such benefits and has no continuing obligation to provide those benefits beyond each fiscal year.
1. I was enrolled in the KelseyCare Advantage MA HMO. What happened to my GBP health coverage on January 1?
To learn more about the HealthSelect MA PPO, please see Question 4 below
2. Is the HealthSelect Medicare Advantage Plan preferred provider organization my only option for health coverage from the GBP?
The GBP offers two statewide health plans for eligible Medicare-enrolled retirees, dependents and surviving dependents. Participants in the Houston area can choose one of them:
3. What if I want to enroll in health coverage not offered through the Texas Employees Group Benefits Program ?
Also, make sure you understand the consequences of waiving GBP health coverage. If you waive your GBP health insurance:
5. What are the key features of HealthSelect Secondary?
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Can I Just Walk Out Of The Hospital
Most of the time, doctors and patients will agree when it is time to be discharged from the hospital. However, there are circumstances when there may be disagreement. In cases where a patient decides to leave against the doctors recommendations, the case will be labeled a discharge against medical advice .
Does Houston Methodist Take Medicare
Houston Methodist Is Once Again In-Network for UnitedHealthcare Medicare Advantage Members. Houston Methodist and UnitedHealthcare have finalized an agreement that ensures UnitedHealthcare members enrolled in Medicare Advantage plans can continue receiving care at Houston Methodist hospitals and from its physicians.
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What Is The Best Cancer Hospital In Texas
The University of Texas MD Anderson Cancer Center has retained its distinction as the No. 1 cancer hospital in the country. MD Anderson tops U.S. News & World Reports 2020-2021 Best Hospitals rankings for cancer care. The University of Texas MD Anderson Cancer Center has retained its distinction as the No.
The Following Is A List Of Insurance That We Currently Accept Please Check With Our Office Or Your Insurance Company To Ensure That We Are In
ü Aetna
ü Blue Cross Blue Shield of Texas
ü BeechStreet
ü Blue Bell – Self-Insured, Direct, Center of Excellence
ü Cigna
ü Consulate General of Egypt – Special Arrangement
ü Coventry
ü Embassy of Egypt – Special Arrangement
ü Evolutions Healthcare Systems
ü Health Economics Corp
ü HealthSmart
ü Independent Medical Systems
ü Interlink Health Services
ü Blue Cross Blue Shield
ü Care Improvements Plus
ü Multiplan/Private Health Care Systems
ü Optum Health Care Solutions – Transplant Only
ü Shell Oil Company – Self-Insured, Direct, Center of Excellence
ü Texas True Choice
üBCBS -Blue Advantage HMO
Please check with our office to make sure we are in-network providers for your plan, as each insurance company has multiple plans.
As a courtesy to our patients, we are happy to file insurance claims for all patients who provide accurate verifiable insurance coverage information. Our staff will make every attempt to obtain insurance policy information, including co-pay, deductible and co-insurance information prior to the date of your appointment. Payment of co-pays and/or deductibles and co-insurance is due at the time of service. If you have questions regarding your insurance coverage, our knowledgeable staff will be happy to assist you.
Sections
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Kelseycare Advantage And Kelsey
As a KelseyCare Advantage member, you can rest assured there is a Kelsey-Seybold affiliated hospital near you, with 28 throughout the Greater Houston area. The hospitals listed here are contracted to provide healthcare coverage to our members. Please note that a referral or prior authorization may be needed for hospital services other than emergency care.
- Brazoria County
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Memorial Hermann Sugar Land Hospital17500 W. Grand Parkway SouthSugar Land, TX 77479
St. Luke’s Sugar Land Hospital1317 Lake Pointe Parkway
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6801 Emmett F. Lowery ExpresswayTexas City, TX 77591
-
Memorial Hermann Memorial City Hospital 921 Gessner Drive
Memorial Hermann Greater Heights Hospital1635 North Loop West
CHI St. Lukes Health-Baylor St. Lukes Medical Center6720 Bertner Avenue
St. Luke’s Hospital at The Vintage20171 Chasewood Park Drive
22999 US Highway 59 North Kingwood, TX 77339
St. Luke’s Patients Medical Center4600 East Sam Houston Parkway SouthPasadena, TX 77505
Clear Lake Regional Medical Center500 Medical Center Blvd.
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Memorial Hermann The Woodlands Medical Center9250 Pinecroft Dr.
St. Luke’s The Woodlands Hospital 17200 St. Luke’s Way
Agreement Grounded In Mutual Support To Expand Access To Value
RICHARDSON, Texas Blue Cross and Blue Shield of Texas and Kelsey-Seybold Clinic have reached an agreement on a new multi-year contract centered around a commitment to increase access to value-based care for members and patients in the Houston region.
The agreement ensures that most BCBSTX members will be able to receive in-network care at Kelsey-Seybold Clinic locations in the Houston region starting Jan. 1, 2020.
We are pleased that we have reached an agreement with Kelsey-Seybold Clinic enabling us to offer their coordinated care to our members, said Dr. Dan McCoy, president, BCBSTX. The contract reflects our mutual commitment to meeting the needs of our members and their patients. Kelsey-Seybolds model of care aligns with our resolve to contract with providers that embrace a high-quality, value-based, collaborative and holistic approach to care for their patients and our members while working to reduce overall health care costs.
Kelsey-Seybold will be in-network for the following BCBSTX plans:
- Blue Essentials HMOSM
- Blue Choice PPO
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Five Year Streak: Kelseycare Advantage Again Awarded 5
HOUSTON—-Oct 15, 2020–
On Fri., Oct. 9, the Centers for Medicare and Medicaid Services announced that KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area Medicare beneficiaries, earned 5-out-of-5 stars in an annual assessment of all Medicare Advantage plans for the fifth year in a row. This 5-out-of-5 star rating applies to the 2021 plan year which begins on Jan. 1.
Achieving a 5-star rating in any given year is difficult, but to achieve this rating five years in a row adds a level of distinction, and places KelseyCare Advantage in an elite class of healthcare organizations. Only three other plans in the nation have ever achieved a 5-star rating, five years in a row.
KelseyCare Advantage is one of two 5-out-of-5 star rated Medicare Advantage plans in the Houston area for the 2021 plan year, and the only plan in the area rated 5-out-of-5 for both Part C and Part D. There are only 10 plans in the nation that have achieved a 5-star rating for both Part C and Part D, and 21 plans who have achieved a 5-star rating overall.
KelseyCare Advantage is offered in 13 counties including: Fort Bend, Harris, Montgomery, portions of Galveston, Austin, Brazoria, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, and Wharton. The plan is affiliated with Kelsey-Seybold Clinic, a group of doctors based in Houston who have been serving Houston-area families for more than 70 years.
CONTACT: Rachelle Khalaf
KEYWORD: UNITED STATES NORTH AMERICA TEXAS
Zacks Rank & Price Performance
Shares of this presently Zacks Rank #3 healthcare provider have gained 0.8% in a year compared with the industrys rally of 33.1%. You can seethe complete list of todays Zacks #1 Rank stocks here.
Image Source: Zacks Investment Research
Other companies in the same space, such as The Joint Corp. JYNT, Molina Healthcare, Inc.MOH and UnitedHealth Group IncorporatedUNH have also surged 510.8%, 75.1% and 36.8% in the same time frame.
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The Insurer Expects The Move Will Expand Access To Care To Include Members Of Its Medicare Advantage Hmo Plans
Major insurer Humana has partnered with multi-specialty group practice Kelsey-Seybold Clinic, signing an in-network agreement that Humana hopes will allow expanded access to value-based care through a broadening of its Medicare Advantage provider network in the Houston area.
The insurer expects the move will expand access to care to include members of its Medicare Advantage HMO plans.
Under this agreement, which becomes effective Jan. 1, 2022, Houston-area members of Humana Medicare Advantage HMO plans will have in-network access to care at more than 26 convenient Kelsey-Seybold Clinic locations, as well as access to more than 500 providers in 55 medical specialties across the Houston-Galveston region.
WHAT’S THE IMPACT
Members of the MA HMO plans will have access to Kelsey-Seybold’s coordinated health services, with multiple specialties enhanced by advanced technologies, including electronic medical record systems, which strive to eliminate duplicate medical testing.
Humana has stressed that the new relationship will emphasize the insurer’s focus on value-based care, which includes more personal time with health professionals and personalized care, as well as access to proactive health screenings and programs focused on preventing illness.
Humana has also said it expects improved care for people living with chronic conditions.
THE LARGER TREND
ON THE RECORD
Medicare And Medicaid Plans Accepted
Medicare is the federal health insurance program for people aged 65 or older and certain younger people with disabilities.
Medicaidis a joint federal and state program that helps pay medical costs for people with limited income who meet certain eligibility criteria. Medicaid also offers financial assistance for nursing home and personal care services. Every state has different rules for Medicaid.
There have been no changes to our participation in Medicare and Medicaid programs. CMS has the right and responsibility to survey any hospital participating in Medicare and Medicaid programs and we welcome their review as we are committed to continuing to provide a safe environment for all of our patients and families.
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Who Is Kelsey
Kelsey-Seybold was founded in 1949 by Mayo Clinic-trained physician Mavis Kelsey, M.D. Kelsey-Seybold is known for quality healthcare and in 2012, was the first medical organization in the United States accredited as an Accountable Care Organization by the prestigious National Committee for Quality Assurance .
