Complaints & Appeals

Complaints

A complaint is when you all Superior to say you are not happy with your health plan, provider or services. You may file a complaint with Superior if you are not happy with the medical care you receive, have trouble getting an appointment or someone treats you rudely.  

For more information or to make a complaint or to file an online complaint, visit the File a Complaint page, or download a Complaint Form.

Appeals

You have the right to appeal Superior’s decision if Medicaid covered services are denied based on lack of medical need. Superior’s denial is called an “action” or “adverse determination.” You can appeal the action if you think Superior:

  • Is stopping coverage for care you think you/your child needs.
  • Is denying coverage for care you think should be covered.
  • Has not paid a hospital bill you think we should pay (claim appeal).
  • Limits a request for a covered service.

You, a doctor or someone else acting on your/your child’s behalf can appeal an action.

A Superior Member Services Advocate can help you file an appeal or answer questions about the status of an appeal. Just call Member Services at 1-866-912-6283.

Medicaid members will have thirty (30) calendar days from the date of the denial letter to appeal the decision. Superior will acknowledge your appeal within five (5) business days of receipt, and complete the appeal within thirty (30) calendar days. This process can be extended up to fourteen (14) calendar days if you ask for an extension. If more time is needed to gather facts about the requested service, you will receive a letter with the reason for the delay.

If you are receiving a service that is being ended, suspended or reduced, you must file an appeal on or before the later of ten (10) days following Superior’s mailing of the denial letter (ten [10] days from the postage stamp date on the envelope), or on the intended effective date of the proposed action.

Superior will keep providing the benefits while your appeal is being reviewed, if:   

  • Your appeal is sent in the required time frame.
  • Your appeal is for a service that was denied or limited that had been previously approved.
  • Your appeal is for a service ordered by a Superior approved provider.

Call Superior Member Services for more information.

You can call us to let us know you want to appeal an action, but you must follow up your phone call with a request in writing, unless an expedited appeal is requested. If you need help, Superior can help you put your appeal in writing. Just call Member Services.

  • STAR Health    1-866-912-6283

You can send an appeal in writing to:

Superior HealthPlan
ATTN: Medical Management
5900 E. Ben White Blvd.
Austin, Texas 78741

FAX: 1-866-918-2266

An expedited appeal is when the health plan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health.

You can ask for an expedited appeal by calling Superior’s Medical Management department at 1-877-398-9461. You can also ask for an expedited appeal in writing and send it to Superior’s Medical Management department at:

Superior HealthPlan
ATTN: Medical Management
5900 E. Ben White Blvd.
Austin, Texas 78741

FAX: 1-866-918-2266

Expedited appeals do not have to be in writing. 

Superior’s Member Advocates can help you with your expedited appeal. You can also have your doctor, a friend, a relative, lawyer or another spokesperson help you.

If your request for an expedited appeal is approved, the following timeframes apply. If your appeal is about an ongoing emergency or denial to continue a hospital stay, Superior will make a decision about your expedited appeal within one (1) business day. Other expedited appeals will be decided within three (3) calendar days. This process can be extended up to fourteen (14) calendar days if more facts are needed. If Superior thinks your appeal does not need to be expedited, Superior will let you know right away. The appeal will still be worked on but the resolution may take up to thirty (30) days.