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Appeals, Grievances, and Coverage Decisions

Appeals, Grievances, and Coverage Decisions

You have the right to request an appeal, file a grievance, and ask for a coverage determination. For status or process questions or to obtain an aggregate number of grievances, appeals, and exceptions filed with the plan, please call toll-free 833.276.8306 or 713.295.5007 (TTY 711) October 1 through March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday, 8:00 a.m. to 8:00 p.m. You may also refer to your Evidence of Coverage for complete details.

Appeals

An appeal is a formal way of asking us to review and change a coverage decision we have made. You may file an appeal when you believe that the service, supplies, or drugs you received should be covered or that they should be covered differently than Community approved or paid them. Your doctor can also request an appeal for you.

  • CALL 833.276.8306 toll-free or local 713.295.5007 Calls to this number are free. Hours are October 1 to March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm. On certain holidays your call will be handled by our automated phone system.
  • TTY
    711
    Calls to this number are free. Hours are October 1 to March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm. On certain holidays your call will be handled by our automated phone system.
  • FAX
    713.295.7036
  • Write
    Appeals & Grievances
    4888 Loop Central Dr. Suite 600
    Houston, TX 77081

Grievance

You may file a grievance when you are unhappy with your care. You can file a grievance against us or one of our network Providers, including complaints about the quality of your care. Grievances do not involve coverage or payment disputes.

  • CALL 833.276.8306 toll-free or 713.295.5007. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday 8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system.
  • TTY
    711
    Calls to this number are free. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday., 8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system.
  • FAX
    713.295.7036
  • Write
    Appeals & Grievances
    4888 Loop Central Dr. Suite 600
    Houston, TX 77081
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 1-800-MEDICARE is available 24 hours a day, 7 days a week, except some federal holidays.
  • Medicare Website
    You can submit a complaint about Community Health Choice (HMO D-SNP) directly to Medicare. Submit an online complaint for Medicare here on the medicare.gov website. (Note: This opens to an external website)

Coverage Decisions for Medical Services

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your medical services.

You may call us if you have questions about our coverage decision process.

  • CALL 833.276.8306 toll-free or 713.295.5007. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday 8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system
  • TTY
    711 
    Calls to this number are free. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday  8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system.
  • FAX
    713.295.7041
  • Write
    Appeals & Grievances
    4888 Loop Central Dr. Suite 600
    Houston, TX 77081

Determinations & Redeterminations for Prescription Drugs

A coverage decision is a decision we make about your benefits and coverage or about the amount we will pay for your medical services.

You may call us if you have questions about our coverage decision process.

  • CALL 833.276.8306 toll-free or 713.295.5007. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday 8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system
  • TTY
    711 
    Calls to this number are free. Hours are October 1 to March 31, 8:00 a.m. to 8:00 p.m. 7 days a week, and April 1 through September 30, Monday through Friday  8:00 a.m. to 8:00 p.m. On certain holidays, your call will be handled by our automated phone system.
  • FAX
    713.295.7041
  • Write
    Appeals & Grievances
    4888 Loop Central Dr. Suite 600
    Houston, TX 77081

H9826_IT_10045_092919_M Last updated March 21, 2024.

Why Choose Community?

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
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