How to Appeal (CHIP Members)

You can file an appeal within 30 days from the day you get the final letter. If we are denying services that you currently receiving, you must file an appeal within ten (10) days of the denial letter or within ten (10) days of the date the denial will take place. If a request for an appeal is received verbally, you/your provider will need to put the appeal in writing. If your provider sends us the appeal, you or your representative will need to sign that request unless you need an expedited appeal. For facts about how to file this appeal using the form that was sent to you or to check on the status of the appeal, call Member Services toll-free at 1-877-DCHP-KIDS (324-7543) for help filing an appeal.

We will send you a letter within five (5) days of receiving your appeal, to let you know that we did receive it. We will complete the appeal review within sixty (60) days. If we need more time to review the appeal, we will send you a letter telling you why we need more time. You can also ask for more time to resolve the appeal. Your appeal can be extended up to fourteen (14) more days.

You may send request for appeal to:
Driscoll Health Plan
Attn: Clinical Appeals Department
615 N Upper Broadway, Suite 1621
Corpus Christi, Texas 78401-0764
Fax: 361-808-2186

Does my request have to be in writing?

You or your provider can appeal verbally or in writing. If a request for an appeal is received verbally, you or your provider will need to put the appeal in writing.

When do I have the right to ask for an appeal?

You may request an appeal anytime a service is limited or denied. If you wish to appeal a denial of a service that is not a covered benefit, then you will need to file a complaint. See pages 52-53 to see how to file a complaint.

Can someone from Driscoll help me file an Appeal?

Yes, call us toll-free at CHIP Member Services: 1-877-4515598 for help with filing an appeal.

What is an Expedited Appeal?

An Expedited Appeal is when the health plan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health.

How do I ask for an Expedited Appeal?

Call Member Services to ask for an expedited appeal. You can ask for an expedited appeal verbally, or in writing. If you need help in filing this appeal, call Member Services and we will arrange for a Member Representative to help you.

We will review your case and get back to you within 3 business days after we receive your request. We will get back with you within one business day if the request is an emergency or for when you are in the hospital.

Does my request have to be in writing?

Your request does not have to be in writing. You or your doctor can ask for this type of appeal. What are the timeframes for an Expedited Appeal? Your request will be reviewed and a response given to you and your doctor within one day of asking for the appeal.

What happens if DHP denies the request for an Expedited Appeal?

If DHP denies your request for an expedited appeal, we will refer your appeal to the regular appeal process. We will call you to inform you of the denial right away. We will then follow up with a letter within 2 calendar days.

Who can help me in filing an Expedited Appeal?

If you need help with filing this appeal, call Member Services at 1-877-451-5598.