Complaint Procedures

If a problem should arise concerning the provision of health services or benefits, please discuss your concern with your FirstCare physician, or call the Customer Services Department at 1-800-884-4901. A written complaint may be directed to SHA, L.L.C. dba FirstCare; Complaints & Appeals, 1901 W. Loop 289, Lubbock, TX 79407, as explained in the "Member Complaint Procedure" section of your Evidence of Coverage.

Any member who is dissatisfied with any aspect of FirstCare operation may file a complaint with our Complaint and Appeals Department.  We will resolve your complaint within 30 days of receiving a written complaint.  Your complaint concerning an emergency or denial of continued stay for hospitalization will be resolved in one business day of receipt of your complaint.  The investigation and resolution shall be concluded in accordance with the medical immediacy of the case.  If you disagree with our resolution, you may appeal our decision. A panel of staff members, physicians or other providers, and FirstCare members will hear the appeal.  You may appear in person before the appeal panel and present evidence.

You may appeal our decision that a service is not medically necessary.  A provider who was not involved in the initial decision will review our decision.  If you disagree with our decision on your appeal or if the situation is an emergency, you have the option to appeal to an independent review organization (IRO).  We will provide information on how to appeal to an IRO at the time of the denial of the appeal, and we will provide the prescribed form which needs to be completed and returned to us to begin the independent review process.  In life-threatening situations, you may contact us by telephone to request the review and provide the required information.

We welcome your complaints and we will not retaliate against any member or employer group because a complaint is filed.

You can also submit your question / comments via our Feedback form.