Doctors and Hospitals
When picking a doctor, you do not need an authorization for an in-network doctor. If you want to see a Medicaid doctor out of network, work with your service coordinator so arrangements are made to get authorizations for your out-of-network provider. To learn more about how to select a primary care provider (PCP), please refer to the STAR Kids Member Handbook.
Do you need help getting to a medical appointment? See transportation services.
You can also contact your service coordinator with any questions or concerns.
- Your right to protect your needs, and understand the information and care you receive
- Your responsibility to give your providers the information they need to take care of you
- How to file a complaint
- How to report health care fraud
If you have questions, please call Service Coordination toll-free at 1-877-301-4394.
Prior Authorization and Referrals
Prior authorizations are not needed for in-network PCPs or other providers. Your child's PCP may send you to a different provider, including a specialist, for special care or treatment. A referral to an in-network specialist is not needed. Blue Cross and Blue Shield of Texas (BCBSTX) will allow members to see out-of-network Medicaid specialists for medically necessary services.
BCBSTX also allows members to see out- of-network OB/GYN providers for medically necessary services. You should notify a service coordinator if you are going to see an out of network OB/GYN to ensure that the provider is loaded in our system so that they can file claims.
Behavioral Health and Substance Abuse Treatment Services
You do not need a referral for behavioral health or substance abuse treatment services to see a Magellan network provider. BCBSTX STAR Kids members get behavioral health/substance abuse services through Magellan Health Services. If you want to see an out-of-network provider, you need to get a prior authorization for to ensure Magellan has the provider information needed to accurately pay claims. A Magellan Health Care Coordinator will work with your child’s service coordinator to ensure your child has access to the behavioral health services needed. You can also call Magellan at 1-800-424-0324.
Emergency and Urgent Care
Emergency or urgent care does not require authorization. You do not need an OK from us or need a referral from your PCP to see a family planning care provider. You can contact your child's service coordinator for help scheduling an appointment at 1-877-301-4394 or call Customer Service at 1-877-688-1811.