Appeals & Grievances

Appeals & Grievances

If you disagree with a decision on your plan’s coverage or payment, you can file an appeal to have the decision reviewed by CHRISTUS Health Plan. If you are unhappy with service and want to make a formal complaint, you can file a grievance.

Appeals and standard grievances can be filed within 60 calendar days from a denial. We can extend the timeframe if good cause is shown by the member.

CHRISTUS Health Plan
Attn: Appeal and Grievance Dept.
PO Box 169009
Irving, TX 75016

  • Appeals must be made in writing, but grievances can also be made over the phone by calling 1-844-282-0380.

In addition to appeals, you can file two types of grievances for health insurance exchange plans:

  • Administrative grievance: a complaint about CHRISTUS Health Plan service or your plan outside of a request for health care services. It includes practices that affected availability, delivery or quality of health care services, including claims payments, reimbursement and terminations of coverage.
  • Adverse determination grievance: a complaint about cancellation of coverage or the denial, reduction or failure to make payment of a benefit based on eligibility or from utilization review. These grievances can be expedited in cases where the life, health or function of the member would be jeopardized, where the provider requests it or where the member would have severe pain that can’t be managed without the care or treatment in the claim.

MM161 & MM162
Last Updated: 2/23/17