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 have a complaint about any service or care you received from BCBSTX or a provider, we want you to tell us if you are not satisfied. If you are a STAR member and you have a complaint, call BCBSTX customer service toll-free at 1-888-657-6061 (TTY 7-1-1)to get help.

STAR members can choose to use the complaint request form PDF Document After you fill it out, mail it to:

Attn: Complaint Coordinator
Blue Cross and Blue Shield of Texas (BCBSTX)
P.O. Box 27838
Albuquerque, NM 87125-7838

You may also file a complaint over the phone. We also have a bilingual Member Advocate that can help you file your complaint. You can reach the member advocate at 1-877-375-9097. If you do not speak English, customer service or our member advocate will get a translator to help you file your complaint. If you are not satisfied with how BCBSTX resolved your complaint, you can do one of the following:

  • Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free).
  • Online: Online Submission Form
  • Mail:
       Texas Health and Human Services Commission
       Office of the Ombudsman, MC H-700
       P.O. Box 13247
       Austin, TX 78711-3247
  • Fax: 1-888-780-8099 (toll-free)

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 may use the appeal request form PDF Document or call us at BCBSTX customer service at 1-888-657-6061; TTY 7-1-1. You can mail your appeal request form to:

Blue Cross and Blue Shield of Texas
c/o Complaints and Appeals Department
P. O. Box 27838
Albuquerque, NM 87125-7838

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

Members must request an appeal within 60 calendar days from the date you receive your Notice of Action letter. The Notice of Action letter explains the reason for the denial of services. If you are not happy with the result of the of the appeal you filed with BCBSTX you can ask for a State fair hearing from HHSC.

We can help you file your request for an appeal. Your health-care provider, a friend, a relative, legal, or spokesperson can also stand for you and ask for an appeal.

How to Request a Fair Hearing

You must ask for a State fair hearing within 120 calendar days from the date you get your appeal denial. Before you can ask for a State fair hearing you must finish the entire BCBSTX appeals process.

To ask for a fair hearing, call us at 1-877-375-9097 (TTY 7-1-1), or you may write to:

Blue Cross and Blue Shield of Texas
PO Box 201166
Austin, Texas 78720-9919

If you ask for a fair hearing, you will get a packet of information letting you know the date, time and location of the hearing. Most fair hearings are held by telephone.

If you have questions about filing a complaint or appeal or about requesting a fair hearing, please call Customer Service at 1-888-657-6061 (TTY 7-1-1). You may also call to check on the status of an existing request.

For more information regarding Complaints, Appeals and the State Fair Hearing, please see Your Rights for an Appeal of an Adverse Determination PDF Document and the Complaints and Appeals section of your Member Handbook PDF Document.

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