Complaints and Appeals

How to File a Complaint with Blue Cross and Blue Shield of Texas (BCBSTX)

We want you to be satisfied with your care. If you are unhappy with BCBSTX or Medicaid services, you, the CHIP member, or someone acting your behalf, can submit a complaint to BCBSTX by calling customer service toll-free at 1-888-657-6061 (TTY 711). Read the HHSC How to Submit a Complaint flyer to find out how to file a complaint.

CHIP members will be asked to file the complaint in writing with BCBSTX. You can download the form online or call customer service to have one mailed to you.

Fill out the complaint request form and mail it to:

Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
PO Box 660717
Dallas, TX 75266-0717

You can reach a bilingual Member Advocate that can help you file your complaint at 1-877-375-9097. The Member Advocate or a customer service representative can also get a translator to help you file a complaint in any language. If you are not happy with how BCBSTX has handled your complaint, you can email ConsumerProtection@tdi.texas.gov.

How to File an Appeal With BCBSTX

When you file an appeal, BCBSTX will take another look at your case to see if there is something else we can do to solve your problem. You can call Customer Service at 1-888-657-6061 (TTY 711) or download the appeal request form and mail to:

Blue Cross and Blue Shield of Texas
Attn: Complaints and Appeals Department
PO Box 660717
Dallas, TX 75266-0717

BCBSTX will send you a letter within five working days to let you know we received your appeal request. You will get an answer within 30 days from when you asked for the appeal.

How to Ask for an Independent Review

If you are not happy with the BCBSTX decision on your appeal, you can ask for an external review through an independent review organization (IRO). You can only file for an external review after you go through the entire BCBSTX appeals process.

You can only ask for an IRO review for:

  • Not getting a service you wanted
  • Not getting all the services approved that you asked for
  • A service ending that was approved before
  • Not getting a service in a timely way

You have four months from the date you received the decision notice to file your external review request. You have the right to an immediate review by an IRO if you have a life-threatening condition. You may also have an immediate review for a denial of prescription drugs or intravenous infusions for which you are currently receiving benefits. The IRO does not have a relationship with BCBSTX or your health care providers

You do not have to pay for the review. You or someone you trust can send a written request to BCBSTX at this address:

Blue Cross and Blue Shield of Texas
C/O Complaints and Appeals Department
P.O. Box 660717
Dallas, TX 75266
Fax: 1-855-235-1055

You, your provider, or someone that you trust can also send a request for an external review directly to one of the following IROs:

Call or write to:

Dane Street
7111 Fairway Drive, Suite 201
Palm Beach Gardens, FL 33418
Ph:888-920-4440

or

MAXIMUS Federal Services
3750 Monroe Avenue, Suite 705
Pittsford, NY 14534
Fax number: 1-888-866-6190

You can find copies of the appeals request and MAXIMUS Federal Services IRO request form on at www.bcbstx.com/CHIP.

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  • 1-888-657-6061 (TTY 711)
  • 8 a.m. to 8 p.m. Central Time Monday through Friday
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