Appeals and Grievances

TexanPlus^® HMO allows members to submit complaints to the Plan which may become either an appeal or a grievance.

• If a member is dissatisfied with the services provided, such as sales, enrollment, or service processes, the member has the right to file a grievance with the plan. The plan will review the grievance, take corrective action as necessary, and notify the member. A grievance does not involve an appeal.
• Members have the right to file an appeal with the plan to request a reversal of a decision not to provide benefits or services. The member may file the appeal with the plan and has additional options to expedite the appeal.
• Value-added benefits included with the Plan do not have appeal rights; however, members may file grievances regarding services received.

For more information about the appeals and grievances policies and procedures, please contact Customer Service at 1-800-958-2707 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) every day. You can find more information about what your plan covers in your Evidence of Coverage.

You may submit your complaint in writing to the Plan to the following address:

• TexanPlus^®
  c/o Appeals and Grievances
  4888 Loop Central Drive, Suite 700
  Houston, Texas 77081
• Or via facsimile: 1-866-245-4120

Please refer to your Evidence of Coverage, section on Grievances, for more information on what to do next.