At Texas Children’s Health Plan, we go far beyond to provide the best quality care.
We understand that our members may have some questions or concerns. To help, we’ve compiled some helpful information and services that better serve our diverse member population, customized to fulfill our member’s needs.
Click on each category below to learn more on what we can assist you with.
Member Services Program Hotlines:
Regular checkups and shots keep your children healthy. You can go to any Texas Health Steps doctor without a referral. To find a Texas Health Steps (THSteps) doctor near you, call us at 1-866-959-2555 or use our "Find a Doctor" tool.
For more information visit www.TXHealthSteps.com
Do not let other people use your/your child’s ID card. If the card is lost or stolen, call Member Services (toll-free) and a Member Advocate will send a new card to you.
CHIP: 1-866-959-6555
STAR: 1-866-959-2555
STAR Kids: 1-800-659-5764
A State Fair Hearing is a chance for you tell the reasons why you think the services you asked for and couldn’t get should be allowed.
Can I ask for a State Fair Hearing? If you, as a member of Texas Children’s Health Plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by Texas Children’s Health Plan, you or your representative must ask for the fair hearing at any time up until 90 days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 90 days, you may lose your right to a State Fair Hearing.To ask for a fair hearing, you or your representative should either send a letter to the health plan or call:
Texas Children’s Health Plan
Attention: Appeals Department NB8390
PO Box 300709
Houston, TX 77230
Fax: 832-825-8796
Phone: 832-828-1001 or 1-866-959-2555
TDD 1-800-735-2989 (Texas Relay) or 7-1-1
HHSC continues to require of Texas Children’s Health Plan to allow an extension for up to 30 days for members to request continuation of benefits after they receive an adverse benefit determination. This continuation of benefits extension time frame will end June 30, 2021.
Starting July 1, 2021, Texas Children’s Health Plan must apply the normal, regular and set timeframes for members to request continuation of benefits, which is no later than 10 days from the date they receive the adverse benefit determination notice.
Texas Children’s Health Plan provides a Member Advocate to assist you if you have a complaint. Our team of member advocates will help you write and file a complaint or appeal on your behalf and monitor it until it is resolved. We have a member advocate dedicated for each line of business and service delivery area. We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.
To have a Member Advocate assigned to you, call 866-219-5411.