Community Health Choice Member Services
STAR and CHIP Members under 21 years of age
Value-Added Service for STAR Members 21 years of age and older
Effective September 1, 2019
Community Health Choice
24 hours a day, 7 days a week
Information is available in English and Spanish. Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. This includes assessment, counseling, and treatment services. Services provided by a licensed psychologist, licensed professional counselor, licensed master’s social worker, advanced clinical practitioner or licensed marriage and family therapist are not covered for Members 21 years and older. You do not need a referral for behavioral (mental) health services or drug and alcohol treatment. Community Health Choice follows the Mental Health Parity Addiction Equity Act (MHPAEA). We review to make sure that requirements for mental health benefits are the same or less than medical benefits.
When can I request a State Fair Hearing?
You can request a State Fair Hearing anytime during or after Community Health Choice’s appeals process. You do not have to follow the internal complaint and appeal’s process before requesting a Fair Hearing.
Can I ask for a State Fair Hearing?
If you, as a Member of the 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 your health plan, you or your representative must ask for the fair hearing within 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 fair hearing. To ask for a fair hearing, either you or your representative should send a letter to the health plan at:
Community Health Choice, Inc.
Member Appeals Coordinator
2636 South Loop West, Suite 125
Houston, TX 77054
- Or call toll-free at 1.888.760.2600.
You have the right to keep getting any service the health plan denied or reduced, at least until the final hearing decision is made, if you ask for a fair hearing by the later of (1) 10 calendar days following the MCO’s mailing of the notice of the Action, or (2) the day the health plan’s letter says your service will be reduced or end. If you do not request a fair hearing by this date, the service the health plan denied will be stopped.
If you ask for a fair hearing, you will get a packet of information letting you know the date, time, and location of the hearing. Most fair hearings are held by telephone. At that time, you or your representative can tell why you need the service the health plan denied. HHSC will give you a final decision within 90 days from the date you asked for the hearing.
State Benefit Programs: Call 2-1-1 Texas (Medicaid/CHIP/CHIP Perinatal) to get information on health care coverage. Local: 2-1-1 | Toll-free: 1.800.964.2777