Yes. Contact Member Services at 1-877-324-7543 for help filing an appeal.
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 STAR and STAR Kids 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
Quality Management Department
Attn: Member Appeals Team
4525 Ayers Street
Corpus Christi, Texas 78415
Phone: 1-877-324-7543
Email: [email protected]
Fax: 361-808-2186
You must file an appeal within 60 calendar days from the date of your denial letter.
If we are denying coverage of services being received, you must file an appeal within 10 business days of the date on the denial letter or before the services end to keep your services.
To continue receiving coverage of your services, you must file an appeal.
A confirmation letter will be sent within five 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.
STAR and STAR Kids Member Services: 1-877-324-7543 (toll-free)
Yes. Contact Member Services at 1-877-324-7543 for help filing an appeal.
You have the right to appeal to the state after the health plan’s internal appeal process has been completed. If you do not agree with our decision, you can ask for a State Fair Hearing with or without External Medical Review. You must make the request in writing for a State Fair Hearing with or without External Medical Review within 120 days of the date on the notice of action. If you do not ask for a State Fair Hearing with or without External Medical Review within 120 days, you may lose your right to a State Fair Hearing with or without External Medical Review. See facts below about how to ask for a State Fair Hearing.
An emergency 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 emergency appeal. The number is 1-877-324-7543. You can ask for an emergency appeal verbally, or in writing. Member Services will arrange for a Member Advocate to help you. DHP shall provide verbal notification of an expedited appeal determination within seventy-two (72) hours or one (1) business day, whichever is sooner, of request, and written confirmation within three (3) calendar days of the determination to approve or reject the request for an expedited appeal.
If DHP denies your request for an emergency appeal, we will refer your appeal to the regular appeal process, and call you to inform you of the denial right away. DHP shall provide verbal notification of an expedited appeal determination within seventy-two (72) hours or one (1) business day, whichever is sooner, of request, and written confirmation within three (3) calendar days of the determination to approve or reject the request for an expedited appeal.
A Member Advocate will help you file an emergency appeal. If you need help, call Member Services at 1-877-324-7543.
If you disagree with the DHP internal appeal decision, you have the right to ask for an External Medical Review. An External Medical Review is an optional, extra step you can take to get the case reviewed for free before the State Fair Hearing occurs. You must request the External Medical Review with a State Fair Hearing, it cannot be requested alone. You may name someone to represent you by contacting the health plan and giving the name of the person you want to represent you, or completing the State Fair Hearing and External Medical Review Request Form. You or your representative must ask for an External Medical Review within 120 days of the date DHP mails the letter with the internal appeal decision. If you do not ask for a State Fair Hearing with or without External Medical Review within 120 days, you may lose your right to an External Medical Review.
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.
If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an emergency State Fair Hearing by writing or calling Driscoll Health Plan. You will need to complete DHP’s internal appeal process to request an Emergency State Fair Hearing, with or without Emergency External Medical Review.
If you ask for a State Fair Hearing, you can also ask for an External Medical Review where independent healthcare experts review your request to receive services. As we mentioned above, this review is an optional, extra step you can take to get your case reviewed for free before your State Fair Hearing. It doesn’t change your right to a State Fair Hearing. If you are happy with the decision from the External Medical Review, the Member or Authorized Representative can choose to withdraw the State Fair Hearing.
You may request a State Fair Hearing and External Medical Review by either:
• Filling out the “State Fair Hearing and External Medical Review Request” Form attached to the appeal decision letter you received and mailing or faxing it to:
Driscoll Health Plan
Attn: State Fair Hearing Coordinator
4525 Ayers Street
Corpus Christi, Texas 78415
Fax Number: 844-381-5437
• Calling Driscoll Health Plan at 1-877-324-7543;
• Emailing us at [email protected]
To check on status of your State Fair Hearing or External Medical Review, call Member Services at 1-877-324-7543.
To learn more see the Appeal, External Medical Review, and State Fair Hearing section of your Member Handbook.
