CHIP Members Rights and Responsibilities

CHIP Member Rights

Members have the right to:
  • You have the right to get accurate, easy-to-understand information to help you make good choices about your child's health plan, doctors, hospitals and other providers.
  • Your health plan must tell you if they use a "limited provider network."  This is a group of doctors and other providers who only refer patients to other doctors who are in the same group.  “Limited provider network” means you cannot see all the doctors who are in your health plan.  If your health plan uses "limited networks," you should check to see that your child's primary care provider and any specialist doctor you might like to see are part of the same "limited network."
  • You have a right to know how your doctors are paid.  Some get a fixed payment no matter how often you visit.  Others get paid based on the services they give to your child.  You have a right to know about what those payments are and how they work.

CHIP Member Responsibilities

You and your health plan both have an interest in seeing your child's health improve. You can help by assuming these responsibilities.
  • You must try to follow healthy habits.  Encourage your child to stay away from tobacco and to eat a healthy diet.
  • You must become involved in the doctor's decisions about your child's treatments.
  • You must work together with your health plan's doctors and other providers to pick treatments for your child that you have all agreed upon.

If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services toll-free at 1-800-368-1019. You also can view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.

CHIP Perinatal Member Rights

CHIP Perinatal members have the right to:
  • You have a right to get accurate, easy-to-understand information to help you make good choices about your unborn child’s health plan, doctors, hospitals and other providers.
  • You have a right to know how the Perinatal providers are paid.  Some may get a fixed payment no matter how often you visit.  Others get paid based on the services they provide for your unborn child.  You have a right to know about what those payments are and how they work.
  • You have a right to know how the health plan decides whether a Perinatal service is covered and/or medically necessary.  You have the right to know about the people in the health plan who decide those things.

CHIP Perinatal Member Responsibilities

  • You and your health plan both have an interest in having your baby born healthy.  You can help by assuming these responsibilities.
  • You must try to follow healthy habits.  Stay away from tobacco and eat a healthy diet.
  • You must become involved in the decisions about your unborn child’s care.

If you think you have been treated unfairly or discriminated against, contact the U.S. Department of Health and Human Services (HHS)

Call toll-free at 1-800-368-1019.  You also can view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr

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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