CHIP Complaints and Appeals Process

When you have a problem, call Customer Service at 1-877-639-2447. They can provide assistance and may be able to resolve your problem while you are on the phone or within days of your call.
You can report a problem over the phone or in writing and we will respond within 5 days. If you tell us the problem by phone, we will send you a one page form to complete and return. If you inform us of a problem, we will write you back with the date we received your letter. This date is important because we have thirty (30) days to make a decision on your complaint.
 
If you are not satisfied with the outcome, you can appeal. You have the right to appeal at any time during this process. You have only 90 days from the date on the letter to file an appeal. If you do not file your appeal within 90 days, you forfeit the right to appeal. The appeal is not a court of law.
 
You may request an appeal by calling Customer Service or the Department of Insurance at 1-800-252-3439 or by writing to:

Texas Department of Insurance
PO Box 149104
Austin, TX 78714-9104
Fax: 512-475 1771
Website: www.tdi.state.tx.us
Email: consumerprotection@tdi.state.tx.us

If FirstCare informs you that your child received services that were not medically necessary and you do not agree, you are entitled to request an independent review.

If you have questions, call Customer Service at 1-877-639-2447.

 

Need Help?
Contact Us!

Call FirstCare CHIP Customer Service at 1-877-639-2447. 

We're open Monday through Friday, from 8 a.m. to 5 p.m., excluding state approved holidays. If you call after hours, please leave us a message. We return all calls the next business day.
 
Our Customer Service Representatives speak both English and Spanish. If you speak another language, we can connect you with an interpreter. You can get information in larger print, audio (CD), braille, or in any other language format, if needed. For help, call FirstCare CHIP Customer Service at 1-877-639-2447.

Members with hearing loss can call FirstCare’s TTY line 1-800-562-5259 or the Relay Texas number 7-1-1. Relay Texas is a free telephone interpreting service to help people with hearing or speech disabilities.

Email: cservice@firstcare.com

Resources

CHIP Service Area CHIP Member News

Ask the Pharmacist

Have a question about a specific drug, or a drug benefit in your plan? Email our Pharmacist for the answers you need!

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? FirstCare members can talk to a nurse by calling 1-855-828-1013. Get answers 24 hours a day, 7 days a week! Information is available in English and Spanish. Interpreter services available upon request. TTY users can call 7-1-1 or 1-800-955-8771. Voice communication is available at 1-800-955-8770.

Utilization Management

Ever wonder how we decide to authorize services? Our decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

Helpful Links and Phone Numbers

CHIPInformation and Referral:
2-1-1 or 1-877-541-7905
Helpline: 1-800-335-8957 
Enrollment Helpline: 1-800-964-2777
TTY: 1-800-735-2989 
MCNA Dental (CHIP)Medicaid & CHIP dental plan for Texas
1-855-691-6262
TTY: 1-800-955-8771
DentaQuest (CHIP)Medicaid & CHIP dental plan for Texas
1-800-508-6775
TTY: 1-800-855-2880
Navitus Health SolutionsFirstCare’s Pharmacy Benefit Manager 
1-877-908-6023
TTY: 7-1-1

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