STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are age 65 or older. Adults in STAR+PLUS get Medicaid health-care and long-term services and supports through a health plan that they choose.
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 Community Health Choice, you have the option to request a State Fair Hearing Review no later than 120 Days after Community Health Choice mails the appeal decision notice. If you do not ask for the fair hearing within 120 days, you may lose your right to a fair hearing. To ask for a fair hearing, you or your representative should send a letter to the health plan at:
Community Health Choice Texas, Inc.
Medical Affairs-Medical Appeals Department
4888 Loop Central Drive, Suite. 600
Houston, TX 77081
Phone: 713.295.2300 or toll-free at 1.888.435.2850
Fax: 713.295.7033
You may mail your Behavioral Health appeal to the address below:
Community Health Choice Texas, Inc.
Attention: Medical Affairs-BH Appeals
P.O. Box 1411 Houston, TX 77230
713.295.2300 or toll-free at 1.888.435.2850 or TTY 7-1-1
Fax: 713.576.0394/Attention: BH Appeals Coordinator
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 from the State Representative. 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.
Can I ask for an Emergency State Fair Hearing?
If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an emergency State Fair Hearing by writing or calling Community Health Choice. To qualify for an emergency State Fair Hearing through HHSC, you must first complete Community Health Choice’s internal appeals process.
Can a Member ask for an External Medical Review?
If a Member, of the health plan, disagrees with the health plan’s internal appeal decision, the Member has the right to ask for an External Medical Review. An External Medical Review is an optional, extra step the Member can take to get the case reviewed for free before the State Fair Hearing. The Member may name someone to represent him or her by writing a letter to the health plan telling Community Health Choice the name of the person the Member wants to represent him or her. A provider may be the Member’s representative. The Member or the Member’s representative must ask for the External Medical Review within 120 days of the date the health plan mails the letter with the internal appeal decision. If the Member does not ask for the External Medical Review within 120 days, the Member may lose his or her right to an External Medical Review.
To ask for an External Medical Review, the Member or the Member’s representative should either:
If the Member asks for an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the Member has the right to keep getting any service the health plan denied, at least until the final State Fair Hearing decision is made. If the Member does not request an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the service the health plan denied will be stopped. The Member may withdraw the Member’s request for an External Medical Review before it is assigned to an Independent Review Organization or while the Independent Review Organization is reviewing the Member’s External Medical Review request. An Independent Review Organization is a third-party organization contracted by HHSC that conducts an External Medical Review during Member appeal processes related to Adverse Benefit Determinations based on functional necessity or medical necessity. An External Medical Review cannot be withdrawn if an Independent Review Organization has already completed the review and made a decision.
Once the External Medical Review decision is received, the Member has the right to withdraw the State Fair Hearing request. The Member may withdraw a State Fair Hearing request orally or in writing by contacting the hearings officer listed on Form 4803, Notice of Hearing. If the Member continues with a State Fair Hearing and the State Fair Hearing decision is different from the Independent
Review Organization decision, it is the State Fair Hearing decision that is final. The State Fair Hearing decision can only uphold or increase Member benefits from the Independent Review Organization decision.
The Member can make both of these requests by contacting Community Health Choice at:
Community Health Choice Texas, Inc.
Medical Appeals Department-Medical Affairs
4888 Loop Central Drive, Suite. 600
Houston, TX 77081
Phone: 713.295.2300 or toll-free at 1.888.435.2850
Fax: 713.295.7033
or the HHSC Intake Team at [email protected].
Can I ask for an emergency External Medical Review?
If you believe that waiting for a standard External Medical Review will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you, your parent or your legally authorized representative may ask for an emergency External Medical Review and emergency State Fair Hearing by writing or calling Community Health Choice. To qualify for an emergency External Medical Review and emergency State Fair Hearing review through HHSC, you must first complete Community Health Choice internal appeals process.
Member Services
Local: 713.295.2300 Toll-Free: 1.888.435.2850 | TTY 7-1-1 for Hearing-Impaired
24 hours a day, 7 days a week, Monday – Friday, excluding state-approved holidays. Access your Member account online 24 hours a day, seven 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. Also call for pharmacy and dental information.
Service Coordination Team
Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.
Service Coordination Team is available 8:00 am – 5:00 pm, Monday- Friday, excluding state approved holidays.
After business hours you can leave a message and calls will be returned within one business day or call Member Services hotline at 1.888.435.2850.
In case of an emergency, call 9-1-1 or go to the nearest hospital. If you have trouble hearing or speaking, please call the TTY/TDD line at 7-1-1
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 Community Health Choice, you have the option to request a State Fair Hearing Review no later than 120 Days after the Community Health Choice mails the appeal decision notice. If you do not ask for the fair hearing within 120 days, you may lose your right to a fair hearing. To ask for a fair hearing, you or your representative should send a letter to the health plan at:
Community Health Choice Texas, Inc.
Medical Affairs-Medical Appeals Department
4888 Loop Central Drive, Suite. 600
Houston, TX 77081
Phone: 713.295.2300 or toll-free at 1.888.435.2850
Fax: 713.295.7033
You may mail your Behavioral Health appeal to the address below:
Community Health Choice Texas, Inc.
Attention: Medical Affairs-BH Appeals
P.O. Box 1411 Houston, TX 77230
713.295.2300 or toll-free at 1.888.435.2850 or TTY 7-1-1
Fax: 713.576.0394/Attention: BH Appeals Coordinator
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 from the State Representative. 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.
Can I ask for an Emergency State Fair Hearing?
If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an emergency State Fair Hearing by writing or calling Community Health Choice. To qualify for an emergency State Fair Hearing through HHSC, you must first complete Community Health Choice’s internal appeals process.
Can a Member ask for an External Medical Review?
If a Member, of the health plan, disagrees with the health plan’s internal appeal decision, the Member has the right to ask for an External Medical Review. An External Medical Review is an optional, extra step the Member can take to get the case reviewed for free before the State Fair Hearing. The Member may name someone to represent him or her by writing a letter to the health plan telling Community Health Choice the name of the person the Member wants to represent him or her. A provider may be the Member’s representative. The Member or the Member’s representative must ask for the External Medical Review within 120 days of the date the health plan mails the letter with the internal appeal decision. If the Member does not ask for the External Medical Review within 120 days, the Member may lose his or her right to an External Medical Review.
To ask for an External Medical Review, the Member or the Member’s representative should either:
If the Member asks for an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the Member has the right to keep getting any service the health plan denied, at least until the final State Fair Hearing decision is made. If the Member does not request an External Medical Review within 10 days from the time the Member gets the appeal decision from the health plan, the service the health plan denied will be stopped. The Member may withdraw the Member’s request for an External Medical Review before it is assigned to an Independent Review Organization or while the Independent Review Organization is reviewing the Member’s External Medical Review request. An Independent Review Organization is a third-party organization contracted by HHSC that conducts an External Medical Review during Member appeal processes related to Adverse Benefit Determinations based on functional necessity or medical necessity. An External Medical Review cannot be withdrawn if an Independent Review Organization has already completed the review and made a decision.
Once the External Medical Review decision is received, the Member has the right to withdraw the State Fair Hearing request. The Member may withdraw a State Fair Hearing request orally or in writing by contacting the hearings officer listed on Form 4803, Notice of Hearing. If the Member continues with a State Fair Hearing and the State Fair Hearing decision is different from the Independent
Review Organization decision, it is the State Fair Hearing decision that is final. The State Fair Hearing decision can only uphold or increase Member benefits from the Independent Review Organization decision.
The Member can make both of these requests by contacting Community Health Choice at:
Community Health Choice Texas, Inc.
Medical Appeals Department-Medical Affairs
4888 Loop Central Drive, Suite. 600
Houston, TX 77081
Phone: 713.295.2300 or toll-free at 1.888.435.2850
Fax: 713.295.7033
or the HHSC Intake Team at [email protected].
Can I ask for an emergency External Medical Review?
If you believe that waiting for a standard External Medical Review will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you, your parent or your legally authorized representative may ask for an emergency External Medical Review and emergency State Fair Hearing by writing or calling Community Health Choice. To qualify for an emergency External Medical Review and emergency State Fair Hearing review through HHSC, you must first complete Community Health Choice internal appeals process.
General Information
Local: 713.295.2222
Toll-Free: 1.877.635.6736
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m
Member Services
Local: 713.295.2294 | Toll-Free: 1.888.760.2600
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m.
Provider Services Hotline
Call 713.295.2295, 8:00 a.m. – 5:00 p.m., Monday – Friday
As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.
“Community Health Choice is always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.”
– Cecily
Member of Community Health Choice
Medicaid
Health Plan
04/01/2027
Marketplace
Health Plan
03/01/2027
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