Frequently Asked Questions

Your Primary Care Provider or another doctor is available by phone 24 hours a day, 7 days a week. If you get sick at night or on the weekend, you can call your Primary Care Provider’s office number for help. The office will have an answering service or message on how to contact your Primary Care Provider. Your Primary Care Provider should return your call within 30 minutes. 

You may also visit an in-network after-hours clinic or urgent care center for sudden illness. You should contact your Primary Care Provider’s office if you are unsure about going to an after-hours clinic or urgent care center. 

Driscoll Health Plan Member Advocates are here to help you with writing complaints and will help you through the complaint process. If you need help with an appeal, a Member Advocate can help you file an appeal and walk you through the process. If you have a question about the covered services or preventative services of Driscoll Health Plan, call Member Services toll-free at 1-877-324-7543. 

Our staff speaks English or Spanish and can help you with questions. We also have special services for members who have trouble reading, hearing, seeing, or speaking a language other than English or Spanish. Members or their legally authorized representatives can ask for the handbook in audio, larger print, Braille, and other languages. To get help, call Member Services toll-free or the TTY line listed on your member ID card. 

As soon as you have your new address, give it to HHSC benefits office by dialing 2-1-1 and call Driscoll Health Plan Member Services Department toll-free, for 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 get a bill, call Member Services and we can help you. We can call the provider’s office for you. You are not responsible for co-pays, deductibles, and services that are not covered by Medicaid.  

Your Primary Care Provider can help you decide if you need to see a specialist. In general, you cannot go to another doctor or get a special service unless your Primary Care Provider agrees to make a referral. Refer to your member handbook for additional information. 

You should ask for Non-Emergency Medical Transportation (NEMT) services as early as possible and at least two business days before you need the NEMT service. In certain circumstances, you may ask for the NEMT service with less notice.

Driscoll Health Plan will provide you with information on how to schedule a ride through SafeRide Health. Call SafeRide Health to schedule and pick up at: 1-833-694-5881. To learn more about transportation, click here https://driscollhealthplan.com/services/transportation/ 

If you need medical care when traveling, call us toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247 and we will help you find a doctor. 

 If you need emergency services while traveling, go to a nearby hospital, then call us toll-free, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247.

If your Medicaid ID card is lost or stolen, you can get a new one by calling toll-free at 1-800-252-8263, or by going online to order or print a temporary card at yourtexasbenfits.com

Emergency Behavioral Health Condition means:  

Any condition, without regard to the nature or cause of the condition, which in the opinion of a prudent layperson, possessing an average knowledge of medicine and health: 

• requires immediate intervention or medical attention without which the Member would present an immediate danger to themselves or others; or 
• which renders the Member incapable of controlling, knowing, or understanding the consequences of their actions. 

 Emergency care is available 24 hours a day, 7 days a week. 

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. 

 Emergency care is available 24 hours a day, 7 days a week. 

 When to seek EMERGENCY medical care: 

• 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. 

You may choose a clinic as your Primary Care Provider. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC). 

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, for Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247

You may change your PCP at any time. If you have seen your PCP within the current month, the change will become effective on the first day of the following month. If you have NOT seen your PCP within the current month, the change will become effective on the first day of the month in which the change is made. The PCP change may be expedited if DHP decides it is in the best interest of the Member and the current PCP.

Driscoll Health Plan wants you to be happy with your Primary Care Provider. You can change your Primary Care Provider if: 

• You are not happy with your Primary Care Provider’s care. 
• You need a different doctor to take care of you. 
• You move farther away from your Primary Care Provider. 
• Your Primary Care Provider is no longer a part of Driscoll Health Plan’s network. 
• You do not get along with your Primary Care Provider. 

You can change your Primary Care Provider by calling Member Services. The Driscoll Health Plan Provider Directory lists all Primary Care Providers. 

A Primary Care Provider is your main doctor, nurse practitioner, or physician assistant who takes care of your medical needs. Your PCP will make sure you get regular checkups. They will write prescriptions for medicines and supplies you need. Your PCP may also refer you to other providers if needed.

• Your Driscoll Health Plan Member ID card and Your Texas Benefits Medicaid card 
• Your child’s vaccination record (if he or she needs vaccines) 
• Medications you are taking