What should I do if I have a complaint? Who do I call? Can someone from Community First help me file a complaint?
We want to help. If you have a complaint, please call Member Services toll-free at: STAR Medicaid: 1-800-434-2347 STAR Kids: 1-855-607-7827 to tell us about your problem. A Community First Health Plans Member Services Advocate can help you file a complaint. Just call: STAR Medicaid: 1-800-434-2347 STAR Kids: 1-855-607-7827 Most of the time, we can help you right away or at the most within a few days.
You may also send us a written complaint request to:
Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249
Attention: Member Services Resolution Unit
How long will it take to process my complaint? What are the requirements and timeframes for filing a complaint?
You can file a complaint with Community First at any time. We will mail you a letter within 5 days to tell you we received your complaint. Then we will mail you our decision within 30 days.
File a complaint:
If you get benefits through Medicaid's STAR program, call your medical plan first. If you don't get the help you need there, you should do one of the following:
a. Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free).
b. Online: Online Submission Form (only works in Internet Explorer)
c. Mail: Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247
d. Fax: 1-888-780-8099 (Toll-Free)
What if I want to file a complaint with HHSC, once I have gone through the Community First complaint process?
Once you have gone through the Community First Health Plans complaint process, you can complain to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to the following address: Texas Health and Human Services Commission Health Plan Operations - H-320 P.O. Box 85200 Austin, TX 78708-5200 ATTN: Resolution Services.
If you can get on the Internet, you can send your complaint in an email to HPM_Complaints@hhsc.state.tx.us.
If you would like more information regarding the appeal process, please click here.