Your request does not have to be in writing. You, your provider or designated representative can ask for this type of appeal verbally or in writing.
Mental Health and Substance Use Services for Adult Members
Your feedback helps us identify areas where we can enhance Driscoll Health Plan services, ensuring we provide the best possible care to our members. If you are dissatisfied with the outcome of your authorization denial letter, you may file an appeal.
You, your provider or designated representative may request an appeal verbally or in writing. Complete the CHIP Appeal Request Form and send by mail, email or fax. If your provider sends the appeal on your behalf, you or your representative must sign that request, unless an emergency appeal is needed.
MAIL:
Driscoll Health Plan
Attn: Member Appeals Team
4525 Ayers Street
Corpus Christi, Texas 78415
You must file an appeal within 60 calendar days from the date on the denial letter.
If we are denying coverage of services currently being received, you must file an appeal within the latter of 10 calendar days from the date on the denial letter or the date services will change.
A confirmation letter will be sent within five business days of receiving your appeal. The appeal review process will be completed within 30 calendar days. If more time is needed, you will be notified via mail. You can also ask for more time to resolve the appeal. The appeal review process can be extended up to 14 days.
If you need additional support, a Driscoll Health Plan Member Advocate can guide you through the appeal process. Our Member Advocates are also available to answer any questions regarding the status of an appeal already in evaluation.
CHIP Member Services: 1-877-451-5598 (toll-free)
Your request does not have to be in writing. You, your provider or designated representative can ask for this type of appeal verbally or in writing.
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.
Yes, call Member Services toll-free at 1-877-451-5598 for help with filing an 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.
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 Advocate to help you.
We will review your case and get back to you within three business days after we receive your request. We will get back with you within one business day if the request is an emergency or when you are in the hospital.
Your request does not have to be in writing. You, your doctor or designated representative can ask for this type of appeal.
Your request will be reviewed and a response given to you and your doctor within one day of asking for the 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 two calendar days.
If you need help with filing this appeal, call Member Services at 1-877-451-5598.
If we deny the appeal (continue to deny the services or treatment described in the denial letter), the member or someone acting on the member’s behalf and the provider of record has the right to request an independent/external review with Maximus within four months of receiving this letter. A member has the right to an immediate external review if Driscoll Health Plan does not issue a timely decision or if the member has a life-threatening condition.
Driscoll Health Plan uses the HHS-Administered Federal External Review process. Maximus manages the review process for HHS. Maximus does not have an affiliation with Driscoll Health Plan or your healthcare providers.
To request an independent/external review, you must complete the Maximus: HHS-Administered Federal External Review Request Form and sign the consent to release medical information to Maximus (included within the form).
You may fax the form to 1-888-866-6190 or mail to:
HHS Federal External Review Request
MAXIMUS Federal Services
3750 Monroe Avenue, Suite 705,
Pittsford, NY 14534
Submit a request via the online portal.
Members may have another person ask for an external review on their behalf. Both the member and the member’s authorized representative will need to complete and sign the HHS Federal External Review Process Appointment of Representative (AOR) Form. You may access the form by visiting www.externalappeal.com.
If you have questions about your external review or to request an AOR Form, please call 1-888-866-6205.
CHIP External Medical Review Form – English
CHIP External Medical Review Form – Spanish
