If you disagree with a health determination made by CHRISTUS Health Plan (for example, being refused service or coverage), you can file an appeal. An appeal is a formal request to have the decision reviewed. An expedited appeal can be made if you or your physician believes that waiting could place the beneficiary’s life, health or ability to regain function in jeopardy.
If you are unhappy with service and want to make a complaint, you can file a grievance. Examples of grievances include if someone is rude to you, you have a long wait on the phone, or you experience poor quality of services from a provider.
CHRISTUS Health Plan
Attn: Appeal and Grievance Dept.
PO Box 169009
Irving, TX 75016
The table below lists the turnaround time for US Family Health Plan appeals and grievance submissions.
|Type of Inquiry||Timeline for Submission||Applies to||Appeal Review||Standard Turnaround Time||Expedited Turnaround Time|
|Payment||90 calendar days from denial date||Denied payment for a service already received||US Family Health Plan||Within 90 calendar days||Not available|
|Service||Three calendar days from denial date||Denied request for a health service not already received||US Family Health Plan||Within 30 calendar days||Within three business days|
|Grievance||Any time||Member dissatisfaction||US Family Health Plan||Within 30 calendar days||Within three business days|
Last Updated: 2/23/17