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 STAR 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). If you are not happy with how BCBSTX has handled your complaint, you can call HHSC to tell them the problem. Read the HHSC How to Submit a Complaint flyer to find out how to file a complaint. You can download the form online or call customer service to have one mailed to you.

STAR members can file a complaint in writing with BCBSTX. 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 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 happy with how BCBSTX resolved your complaint, you can contact the HHSC Office of the Ombudsman in one of the ways listed below:

   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 or call us at BCBSTX customer service at 1-888-657-6061 (TTY 711). You can mail your appeal request form 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 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 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 711), 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 711). 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 and the Complaints and Appeals section of your Member Handbook.
 

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