Member FAQ - UnitedHealthcare Health Plan (2024)

I haven’t received my UnitedHealthcare health ID card. What do I need to do?

There are several ways to obtain your health ID card from UnitedHealthcare:

• Go to myuhc.com/exchange to set up your online member account to view your health ID card.
• Download the UnitedHealthcare app to get on-the-go access to your health ID card and even save it to your digital wallet.
• Call a UnitedHealthcare member service advocate 1-877-369-2073 (TTY: 711) from 8 a.m. to 8 p.m. local time for assistance. (October-March: available 7 days a week, April-September: available Monday through Friday)

Even if you have not received your UnitedHealthcare health ID card, you may still be seen at a Kelsey-Seybold Clinic. We’ll just need to verify some of your information.

I have questions about my benefits. How can I get information?

• UnitedHealthcare is here to help you navigate your health plan with one-on-one support so you can use all your plan benefits, pay your monthly premium, and more. You can do it all at myuhc.com/exchange or the UnitedHealthcare app.
• For more information about your benefits and coverage, you can also live chat with a UnitedHealthcare member advocate on the UnitedHealthcare app or by visiting myuhc.com/exchangeto get your question answered in real time by a real person.
• You can also call a UnitedHealthcare member service advocate for information about your benefits and coverage at 1-877-369-2073 (TTY: 711) from 8 a.m. to 8 p.m. local time (October-March: available 7 days a week, April-September: available Monday through Friday)

Can I continue to see my specialist who is not with Kelsey-Seybold?

• UnitedHealthcare, in partnership with Kelsey-Seybold Clinic, gives you access to Kelsey-Seybold Clinic's network of specialists at over 35 convenient locations. As part of a UnitedHealthcare Copay Focus plan, you pay a set amount (copay) for each visit with a Kelsey-Seybold Clinic specialist. If you receive care from a provider who is not part of Kelsey-Seybold Clinic, without prior approval from Kelsey-Seybold, your services will not be covered, and you will be responsible for the entire out-of-pocket cost.
• If you are under active cancer treatment or are pregnant, you may be eligible for a transition of care approval. Note, you must receive approval from Kelsey-Seybold to continue your care with a non-Kelsey-Seybold Clinic provider.
• Have your specialist contact Kelsey-Seybold provider services to discuss transition of care options and approval/authorization at 713-442-2304 (TTY: 711) from 8 a.m. to 8 p.m. local time (October-March: available 7 Days a week, April-September: available Monday through Friday)

How do I schedule an appointment?

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 713-442-0000.

Can I schedule a Video Visit with Kelsey-Seybold?

What happens if I see a doctor not affiliated with Kelsey-Seybold?

• One of the advantages of receiving your care from Kelsey-Seybold is that you can see any doctor, at any location, with no referral needed to see most Kelsey-Seybold specialists.
• Since this type of health plan works with the Kelsey-Seybold health system as the primary network partner in order to provide coordinated, high quality and cost-effective care, if you receive care from another provider without prior authorization from your Kelsey-Seybold provider, your services will not be covered (even if that provider is in network with other UnitedHealthcare plans). 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 health care needs.

I have a chronic health condition and I am new to Kelsey-Seybold. How do I get started?

• 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 713-442-0000 and schedule directly with no referral to see most Kelsey-Seybold specialists.

How can I find a doctor at Kelsey-Seybold that speaks my language?

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

  

What if I need an on-site translator for my in-person appointment?

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

Can I continue to see my specialist who is not with Kelsey-Seybold?

• If you receive care from a provider not in the UnitedHealthcarenetwork, your services will not be covered, and you will be responsible for the entire cost. Kelsey-Seybold is now your medical home in your UnitedHealthcare 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 UnitedHealthcareby calling the number on your insurance card to discuss transition of care options and approval/authorization.

What do I need to bring to my first appointment at Kelsey-Seybold?

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.

What if I have a medical emergency?

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.

What if I need to see the doctor the same day for an illness or injury?

• Kelsey-Seybold offers same-day and next-day in-person and Virtual visit appointments for adults and children. Virtual visit appointments with a Kelsey-Seybold provider are available 7 days a week until 9 p.m. for adults (ages 18+). Virtual visits can be scheduled on MyKelseyOnline or through our 24/7 Contact Center by calling713-442-0000.
• Kelsey-Seybold Clinic does not offer urgent care services. Visit myuhc.com/exchange for information on urgent care facilities in your UnitedHealthcare plan’s network .

Can I walk in at any Kelsey-Seybold Clinic location to see the doctor?

What hospitals and specialists are affiliated with Kelsey-Seybold?

• Your Kelsey-Seybold doctors will direct your care to an affiliated hospital, which includes CHI St. Luke’s, HCA and Memorial Hermann hospitals. Patients needing specialty care will be seen by Kelsey-Seybold Clinic specialists in more than 65 medical specialties. At Kelsey-Seybold, you do not need a referral to see most Kelsey-Seybold specialists.
• 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.

Which hospital will I go to if I have a pre-scheduled procedure?

• 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, HCA and Memorial Hermann Healthcare facilities in the Greater Houston area.

Where would I go to get cancer treatment?

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: www.kelsey-seybold.com/cancercenter.

What outpatient surgery centers does Kelsey-Seybold refer to?

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 2023 and 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: www.kelsey-seybold.com/asc.

I’m out of refills and need authorization to refill my prescription(s) immediately. What do I do?

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 temporary one-time supply of your medication.
• Option 2: Contact the pharmacy where you last filled your prescription and ask them to get a refill exception from your current provider for 1 month.
• Option 3: Sign in or registermyuhc.com/exchange for checking if medications are covered, network pharmacies, and more. You can also set up your member account with UnitedHealthcarefor more prescription options and benefit coverage information.
• Option 4: Schedule a Video virtual 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. Schedule a virtual visit through MyKelseyOnline or through our 24/7 Contact Center by calling 713-442-0000.

How do I transfer my medical records to Kelsey-Seybold?

• 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

I’m currently pregnant or undergoing active cancer treatment. Can I continue to receive care from my current doctor who is not with Kelsey-Seybold?

• If you are under active cancer treatment or are pregnant, you may be eligible for a transition of care approval. Note, you must receive approval from Kelsey-Seybold to continue your care with a non-Kelsey-Seybold Clinic provider. Have your specialist contact Kelsey-Seybold provider services to discuss transition of care options and approval/authorization at 713-442-2304 (TTY: 711) from 8 a.m. to 5 p.m. local time, Monday through Friday.
• You may be eligible to continue care with your current provider if you are being treated for a condition that qualifies you to do so. In order to find out if you qualify to continue your care with your non-network provider you will need an approval from Kelsey- Seybold Clinic.

Why choose Kelsey-Seybold Clinic for your care?

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 650 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 with no referral required.
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 713-442-0000 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

Where does Kelsey-Seybold care for patients?

Kelsey-Seybold cares for patients throughout the Greater Houston area at 35 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.