Can I ask for a State Fair Hearing?

If you, as a Member of DHP, disagree with the health plan’s internal appeal decision, you have the right to ask for a State Fair Hearing. You may name someone to represent you by writing a letter to DHP telling them the name of the person you want to represent you, or by completing the State Fair Hearing and External Medical Review Request Form. A doctor or other medical provider may be your representative. If you want to challenge a decision made by DHP, you or your representative must ask for the State Fair Hearing, with or without External Medical Review, within 120 days of the date on the letter DHP mails with the internal appeal decision. If you do not ask for the State Fair Hearing within 120 days, you may lose your right to a State Fair Hearing. To ask for a fair hearing, you or your representative should either call or send a letter to the health plan.

You have the right to keep getting any service DHP denied or reduced, based on previously authorized services, at least until the final State Fair Hearing decision is made. If you want your services to continue, you must make your request by (date must be the later of the following: date 10 Days from the date this notice is mailed or the date services will change)If you ask for a State Fair Hearing, you will get a packet of information letting you know the date, time, and location of the hearing. Most State Fair Hearings are held by phone. At that time, you or your representative can tell why you need the service the health plan denied. HHSC will give you a final decision within 90 days from the date you asked for the hearing.

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