What do I bring with me to my doctor’s appointments?
Bring a list of medicines you and/or your child are taking. If you take your child, also remember to take your child’s shot records.
STAR Members: You must take both your Texas Benefit Medicaid Card and your DHP ID Card.
CHIP Members: You must take your DHP ID Card.
How do I change my Primary Care Provider (PCP)?
Having a medical home is very important. It makes sure that you and/or your child have a doctor that you know and trust for all your medical needs. If for any reason you need to change your PCP, call Member Services at 1-877-220-6376 (Nueces) or 1-855-425-3247 (Hidalgo).
When will my PCP change become effective?
You may change your PCP at anytime. If you call BEFORE the 5th of the month, the change will become effective immediately. If you call AFTER the 5th of the month, the change will be effective the first of the next month. You need to continue to see your current PCP until the change is effective.
Can a clinic be my PCP?
You and/or your child may choose a clinic as your PCP. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC). A hospital-based clinic such as the Spohn Family Health Clinics can also be your PCP. To choose a clinic as your PCP or if you have questions, call Member Services at 1-877-220-6376 (Nueces) or 1-855-425-3247 (Hidalgo).
How many times may I change my PCP?
There is no limit on how many times you can change your or your child’s primary care provider. You can change primary care providers by calling us toll-free at Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-4253247
What is an emergency medical condition?
Emergency medical condition means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:
- Placing the patient’s health in serious jeopardy;
- Serious impairment of bodily functions;
- Serious dysfunction of any bodily organ or part;
- Serious disfigurement; or
- In the case of a pregnant women, serious jeopardy to the health of a woman and her unborn child.
You and/or your child have an EMERGENCY medical need if:
- You think you and/or your child’s condition is life threatening;
- You and/or your child has serious pain; or
- Serious harm could come to you and/or your child if you do not get immediate medical care.
How do I get medical care after my PCP’s office is closed?
If you and/or your child gets sick at night or on the weekend and cannot wait to get medical care, call your PCP for advice. If you and/or your child have a fever or a sore throat and you are not sure what to do, call your PCP’s office. Your PCP or another doctor are available by phone 24 hours a day, 7 days a week.
What do I do if my child and/or I become sick when out of town or traveling?
If you and/or your child get sick while you are out of town or out of state, call your PCP. Your PCP’s phone number is listed on the front of your DHP ID card. You may also call Member Services at the number on the back of your ID card. If you and/or your child have an emergency while you are out of town or out of state, go to the nearest ER.
Driscoll Health Plan does not cover any care outside of the United States.
If I don’t have a car, can I get a ride to the doctor’s office?
If you are a STAR member and need a ride to the doctor’s office, you can get help from the Medical Transportation Program (MTP). Call MTP as soon as you know you will need a ride. The number is 1-877-633-8747.
If you are CHIP member and need a ride to the doctor’s office, call Member Services at 1-877-220-6376 (Nueces) or 1-855-425-3247 (Hidalgo). We can help you with a ride to the doctor.
When do I need a referral?
Your PCP will tell you when you and/or your child need to see a specialist. Your PCP will make sure that you and/or your child get the special care needed. Most of the time you cannot go to another doctor or get a special service if your PCP does not agree to make a referral. A referral is when your PCP sends you to another doctor. You should expect the specialist to give you an appointment within 2 weeks for non-urgent care or within 24 hours for urgent care.
What should I do if I get a bill?
If you are a STAR member: You are not responsible for co-pays or deductibles. If you get a bill, call Member Services and we can help you. Have your Member ID card and the bill when you call. We can call the provider’s office for you. You are responsible for services that are not covered by Medicaid. The following are not covered by DHP.
• Going to a specialist without getting a referral
• Going to an out-of-network provider without getting a referral
• Choosing to go to a Urgent Care instead of an Emergency Room when you are out of town
If you are a CHIP member: You may be responsible for co-pays or deductibles depending on your income. If you do get a bill, call Member Services and we can help you. Have your Member ID card and the bill when you call.
If you are a CHIP Perinate member: In the CHIP Perinatal Program, there are no co-payments and no deductibles for Members to pay out-of-pocket. All Covered Services should be paid by DHP directly to your Provider.
Who do I call if I get a bill from my/my child’s doctor?
If you are a CHIP member: If you get a bill from your Primary Care Provider or other Doctor, call Member Services at 1-877-451-5598 and someone will call the Doctor’s office. We will help to explain your benefits and copayments.
What do I have to do if I move?
You must report your new address before getting any services in your new area unless it is an emergency. If you have moved out of the DHP service area you will be reassigned to a new health plan. You will continue to get care through DHP until the address is changed.
If you are a STAR member: As soon as you have your new address, give it to HHSC benefits office and call Driscoll Health Plan Member Services Department at Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247. Before you get Medicaid services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you are a CHIP member: As soon as you have your new address, give it to HHSC by calling 2-1-1 or updating your account on yourtexasbenefits.com and call the Driscoll Health Plan Member Services Department at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you are a CHIP Perinate member: As soon as you have your new address, give it to the HHSC by calling 2-1-1, or updating your account on yourtexasbenefits.com and call Driscoll Health Plan Member Services at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan Member Services, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
What do I do if I lost my Member ID Card?
If you lose your ID card, call us right away at 1-877-DCHP-KIDS to get a new one. We can mail you one right away. If you move or change phone numbers, call us so we can send you another ID card. We always need to have your correct address and phone number.
What do I do if I need member materials in a different format?
Our staff speaks English or Spanish and can help you with questions. We also have special services for people who have trouble reading, hearing, seeing or speaking a language other than English or Spanish. You can ask for member materials in audio, larger print, Braille, other languages. To get help, call our Member Services toll-free number on your ID card.
Who do I contact for a ride?
One Call offers NEMT (Non-Emergency Medical Transportation) services to DHP members.
Phone Reservations: 1-833-694-5881
All standard-distance medical transportation should be requested 48 hours in advance and long-distance trips should be requested 5 business days in advance.
You can contact One Call’s “Where’s my ride?” phone number at 1-833-694-5881 to locate your driver upon pick-up.
For more information visit: driscollhealthplan.com/transportation