Out-of-Network Coverage

For Certain Situations, Going Out of Network Is Covered

With all KelseyCare Advantage plans, you get open access to Kelsey-Seybold Clinic’s premier multispecialty physician group, an extensive network of primary care providers and specialists. But there are times when you may choose to receive care from an out-of-network provider. Some of our plans (HMO-POS) do provide some coverage for out-of-network medical services. Providers must be willing to bill KelseyCare Advantage.

If you are enrolled in a KelseyCare Advantage HMO plan, you can still use an out-of-network provider if:

• You need emergency or urgent care and an in-network provider is unavailable or isn’t nearby.
• You need Medicare-covered services that our in-network providers are unable to provide. In this case, you must have authorization from us to seek non-emergency care from a contracted affiliate provider. You’ll be charged the same as if your provider was in-network.