State Fair Hearings
If you are a Medicaid member and you disagree with Superior’s final decision, you have the right to ask for a fair hearing. A member can file for a fair hearing at any time during Superior’s appeals process. 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 your health plan, you or your representative must ask for the fair hearing within ninety (90) days of the date on Superior’s letter with the decision. If you do not ask for the fair hearing within ninety (90) days, you may lose your right to a fair hearing. To ask for a fair hearing or for questions about the fair hearing process or the status of your fair hearing, you or your representative should send a letter to Superior at:
Attn: Fair Hearings Coordinator
5900 E. Ben White Blvd.
Austin, Texas 78741
You may also call Superior at 1-877-398-9461.
You have the right to keep getting any service Superior denied or reduced, at least until the final hearing decision is made if you ask for a fair hearing by the later of ten (10) days following Superior’s mailing of the notice of action, or the day the health plan’s letter says your service will be reduced or end. If you do not request a fair hearing by this date, the service the health plan denied will be stopped.
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. Most fair hearings are held by telephone. At that time, you or your representative can tell why you need the service that the health plan denied.
HHSC will give you a final decision within ninety (90) days from the date you asked for the hearing.