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, a STAR Kids member, parent, guardian or LAR can submit a complaint to BCBSTX by calling customer service toll-free at 1-877-688-1811 (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 also file a complaint in writing with BCBSTX by filling out the complaint request form. Mail the completed form to:

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

BCBSTX also has Member Advocates as part of our Member Outreach team based in our Austin offices. The Member Advocate can help you file a complaint or help you find out about a previous complaint you have filed. To reach a Member Advocate in the Central Service Area, call 1-855-497-0857 (TTY 711). Members in the Travis Service Area can reach a Member Advocate at 1-877-375-9097 (TTY 711).

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:

  • 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 can call us to file an appeal at 1-877-688-1811 (TTY 711) or you can write to:

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

You can also download the Member Appeal Request Form and mail it to us at the address above.

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 the Member Advocate in the Travis service area at 1-877-375-9097 (TTY 711) or for the Member Advocate in the Central MRSA service area, call 1-855-497-0857 (TTY 711). You may also 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 1-877-688-1811 (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 the Complaints and Appeals section of your Member Handbook and Your Rights for Appeal of an Adverse Determination.
 

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To learn more about Complaints and Appeals, see the Member Handbook

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