Don't Risk Losing Your Coverage

Each quarter, BCBSTX holds a Member Advisory Group (MAG) Meeting so that we can find out how we can serve you better.

If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please call the member advocate toll-free for details at 1-877-375-9097 (TTY: 711).

Learn about upcoming MAG meetings.

You must choose a PCP from the Provider Network when you join. You can choose a different PCP for each member. A PCP is your main health care provider and will arrange your care with other doctors and hospitals. Your PCP can be a:

• Pediatrician
• Family or General Practitioner
• Obstetrician/Gynecologist (OB/GYN)
• Internist (Internal Medicine)
• Nurse Practitioner (NP) or Physician Assistant (PA)
• Clinic such as Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs)

You can call customer service for help choosing a PCP or use the Provider Finder^®.

BCBSTX allows members with special health care needs to have direct access to the right specialists for their conditions and identified needs. This includes a standing referral to a specialty doctor, or having a specialist as a PCP if needed.

Mental Health/Substance use services do not need an OK from your PCP when you are not in the hospital, but you do have to see a BCBSTX provider.

Some PCPs and OB/GYNs offer family planning. You do not need an OK from your PCP to get family planning help. Members may use any qualified family planning clinic, certified nurse midwife or provider. The provider does not need to be part of BCBSTX.

If you need help finding a specialty doctor, mental health/substance use services or an OB/GYN provider, call the Customer Advocate Department at 1-888-657-6061 (TTY: 711).

You do not need a referral to get emergency services. You should call your child’s PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.

Some CHIP members have copays. Your member's card shows if you have one. You can check copays for different services, based on income guidelines.

Review your Member Rights and Responsibilities.

If you are not satisfied with your care, you can file a complaint.

You have the right to ask for an appeal. If you are not happy with the BCBSTX decision on your appeal, you can ask for an immediate external review through an independent review organization at no cost to you. You can file for an external review after you go through the entire BCBSTX appeals process.

Learn how to file an appeal with BCBSTX or ask for a review of your appeal from an IRO.

Call us at 1-888-657-6061 (TTY: 711) to replace your ID card if it is lost.

Review the HIPAA Notice of Privacy Practices.

Visit the Office of Consumer Credit Commissions (OCCC) website to get tools and skills to help you make informed financial decisions. The OCCC has resources to help understand your financial choices and obligations. Knowing your choices makes it easier to manage your personal finances so you can meet your financial goals.

We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website.

Call our Customer Advocate Department at 1-888-657-6061 (TTY: 711). We are open 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday. You can speak with someone in English or Spanish. You can also speak with someone about how to get information in other languages or formats at no extra charge. You may also request interpreter services.

You may leave a voice mail outside of our normal business hours or on weekends and holidays.

If you are experiencing an emergency, call 911 or go to the nearest hospital emergency room.

For the Behavioral Health Services Hotline, call us at 1-888-657-6061 (TTY: 711). You can call 24 hours a day, 7 days a week.

You can speak with someone in English or Spanish. You may also request interpreter services.

Mental Health/Substance Use services do not need an OK from your PCP when you are not in the hospital, but you do have to see an in-network provider.

BCBSTX offers emergency and crisis support. If you or your child have a mental health emergency, you may call at any time of day or night, and on any day of the week.

For the 24/7 Nurseline, call 1-844-971-8906 (TTY: 711). You can speak with someone in English or Spanish. You may also request interpreter services.

This help line is staffed 24 hours a day, 7 days a week with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.
 

If you need help choosing a health plan, call 1-800-964-2777. You can call Monday to Friday, 8:00 a.m. to 6:00 p.m. Central Time.

If your provider needs to contact us, they may call the Provider Services Hotline at 1-877-560-8055 from 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday.

Your provider can contact us with questions about eligibility, benefits, provider network referrals or claim statuses. They can also contact us about appeals and complaints.

To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call the BCBSTX Customer Advocate Department at 1-888-657-6061 (TTY/TDD: 711).

Your child's prescription benefits are administered by BCBSTX. For questions about drug coverage, please contact us at 1-888-657-6061 (TTY: 711).

Review your child's drug coverage.

Your child's vision coverage includes an eye exam every 12 months and one pair of non-prosthetic eyewear every 12 months.

Your child’s vision benefits are administered by Davis Vision^®. For questions about your child's vision coverage, please call the BCBSTX Customer Advocate Department at 1-888-657-6061 (TTY: 711).

Review your child's vision coverage.
 

Your child's dental benefits are administered by either DentaQuest^® or MCNA Dental. Please call them directly to learn more about your child's dental coverage:

Call DentaQuest at 1-800-516-0165 and MCNA Dental at 1-800-494-6262.

If you do not know your child's CHIP dental plan, call the CHIP enrollment broker at 1-800-964-2777.

Review your child’s dental coverage.

BCBSTX works with you for mental health and substance use services. For questions about your behavioral health coverage, please call us at 1-877-688-1811 (TTY: 711).

Review your child's behavioral health coverage.

Each quarter, BCBSTX holds a Member Advisory Group (MAG) meeting so that we can find out how we can serve you better.

If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please contact the STAR Kids member advocate in your area for details. For the Travis Service Area call toll-free at 1-877-375-9097, or in MRSA Central call 1-855-497-0857 (TTY: 711).

Learn about upcoming MAG meetings.

Please choose a PCP from the provider network when you join. If your child sees and out-of-network PCP or a PCP from a non-Medicaid plan, we can help you stay with that PCP. You should let us know If you would like your child's specialist to be their PCP.

Please call Service Coordination so we can get information on PCP that you want to use, and we will help get the appropriate PCP assigned. After you choose a PCP, you will then get a new ID card that shows “Commercial PCP” or “Dual Eligible” for members that have Medicare. You can call customer service for help choosing an in-network PCP or you can use Provider Finder^®.

You do not need referrals to see in-network specialists. BCBSTX allows you to see out-of-network Medicaid specialists for medically necessary services.

BCBSTX also allows you 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.

BCBSTX STAR Kids members do not need a referral for behavioral health or substance use treatment services to see an in-network provider.

If you want to see an out-of-network provider, you need to get a prior authorization to ensure BCBSTX has the provider information needed to accurately pay claims. A  Service Coordinator will work with you to ensure your child has access to the behavioral health services needed. You can also call your BCBSTX Service Coordinator at 1-877-301-4394 or the Customer Advocate Department at 1-877-688-1811 (TTY: 711).

Review your Member Rights and Responsibilities.

If you are not satisfied with your care, you can file a complaint.

If you do not agree with a decision BCBSTX has made about your request for benefits or services, you have the right to ask for a State Fair Hearing from the Health and Human Services Commission (HHSC). The HHSC hearings officers will hear your case, look at the evidence and make a decision based on state and federal rules, regulations and laws.

If you ask for a State Fair Hearing, you can also ask for an External Medical Review where independent health care experts review your request to receive services. The External Medical Review is an optional, extra step you can take to get your case reviewed for free before your State Fair Hearing.

To ask for an appeal or a fair hearing, call the Member Advocate in the Travis service area at 1-877-375-9097 (TTY: 711) from 8:30 a.m. to 5:00 p.m. Central Time, Monday to Friday. Find out more about how to ask for an appeal, State Fair Hearing or External Medical Review.

Call us at 1-877-688-1811 (TTY: 711) to replace your ID card if it is lost.

Review the HIPAA Notice of Privacy Practices.

Visit the Office of Consumer Credit Commissions (OCCC) website to get tools and skills to help you make informed financial decisions. The OCCC has resources to help understand your financial choices and obligations. Knowing your choices makes it easier to manage your personal finances so you can meet your financial goals.

We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website.

Call our Customer Advocate Department at 1-877-688-1811 (TTY: 711). We are open 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday. You can speak with someone in English or Spanish. You can also speak with someone about how to get information in other languages or formats at no extra charge. You may also request interpreter services.

You may leave a voice mail outside of our normal business hours or on weekends and holidays.

If you are experiencing an emergency, call 911 or go to the nearest hospital emergency room.

Service coordination assists you and your child in coordinating acute and long-term care services. All members receiving long-term services and supports, or those who request them will receive service coordination services from BCBSTX STAR Kids.

For Service Coordination, call 1-877-301-4394 (TTY: 711), 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday.

Find more information about your child's assigned service coordinator by logging in to Blue Access for Members^SM (BAM). In BAM, you can view the service coordinator's name, phone number, and email address.
 

For the Behavioral Health Services Hotline, call us at 1-877-688-1811 (TTY: 711). You can call 24 hours a day, 7 days a week.

You can speak with someone in English or Spanish. You may also request interpreter services.

Mental Health/Substance Use services do not need an OK from your PCP when you are not in the hospital, but you do have to see an in-network provider.

BCBSTX offers emergency and crisis support. If you or your child have a mental health emergency, you may call at any time of day or night, and on any day of the week.

For the 24/7 Nurseline, call 1-855-802-4614 (TTY: 711). You can speak with someone in English or Spanish. You may also request interpreter services.

This help line is staffed 24 hours a day, 7 days a week with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself.

If you need to contact Texas Health Steps, call them toll-free at 1-877-847-8377 (1-877-THSTEPS).

Learn more about Texas Health Steps.

If you need help choosing a health plan, 1-877-782-6440. You can call Monday to Friday, 8:00 a.m. to 6:00 p.m. Central Time.

If your provider needs to contact us, they may call the Provider Services Hotline at 1-877-784-6802 from 8:00 a.m. to 8:00 p.m. Central Time, Monday through Friday.

Your provider can contact us with questions about eligibility, benefits, provider network referrals or claim statuses. They can also contact us about appeals and complaints.

To get auxiliary aids and services, or to get written or oral interpretation to understand the information given to you, including materials in alternative formats such as large print, braille or other languages, please call the BCBSTX Customer Advocate Department at 1-877-688-1811 (TTY/TDD: 711).

Your child's prescription benefits are administered by BCBSTX. For questions about drug coverage, please contact us at 1-877-688-1811 (TTY: 711).

Review your child's drug coverage.

Your child's vision coverage includes an eye exam every 12 months and one pair of non-prosthetic eyewear every 12 months.

Your child’s vision benefits are administered by Davis Vision^®. For questions about your child's vision coverage, please call the BCBSTX Customer Advocate Department at 1-877-688-1811 (TTY: 711).

Review your child's vision coverage.

Your child's dental benefits are administered by either DentaQuest^® or MCNA Dental. Please call them directly to learn more about your child's dental coverage:

Call DentaQuest at 1-800-516-0165 and MCNA Dental at 1-800-494-6262.

If you do not know your child's CHIP dental plan, call the STAR Kids enrollment broker at 1-877-782-6440 (toll-free) 8 a.m. to 6 p.m. Central Time, Monday to Friday. If you have a speech or hearing disability, call 711 or 1-800-735-2989 (toll-free).

Review your child’s dental coverage.

BCBSTX works with you for mental health and substance use services. For questions about your behavioral health coverage, please call us at 1-877-688-181 (TTY: 711).

Review your child's behavioral health coverage.

STAR Kids members can get NEMT rides to medical appointments, at no cost, as a covered benefit through Texas Medicaid. Call 1-866-824-1565 (TTY: 711) between 8 a.m. and 5 p.m. Central Time, Monday through Friday, for more information about NEMT or to schedule a ride. Rides are available 24 hours a day, 7 days a week. Call the NEMT Where’s My Ride line 24 hours a day, seven days a week at 1-866-824-1565 (TTY: 711) to make changes to your reservation, cancel a trip or ask questions about a ride that has already been scheduled.