What is a Fair Hearing?
A Fair Hearing is a Level 2 Appeal which is filed for Medicaid services only. If we say no to part or all of your Level 1 Appeal, we will send you a letter. If your problem is about a Texas Medicaid service or item, you can ask for a Level 2 Appeal (Fair Hearing). Requests for a Fair Hearing are filed with Cigna-HealthSpring CarePlan but reviewed by the HHSC Appeals Division.
If you want to request a Fair Hearing, you must contact Cigna-HealthSpring CarePlan in writing. We will send your Fair Hearing request to the HHSC Appeals Division. You or your representative must ask for a Fair Hearing within 120 days of the date on the letter telling you we were denying your Level 1 Appeal to our plan. If you have a good reason for being late, the HHSC Appeals Division may extend this deadline for you.
Mail your written request to:
Cigna-HealthSpring CarePlan Appeals
PO Box 211088
Bedford, TX 76095
Toll-free fax: 1 (877) 809-0783
Or you can call Member Services at 1 (877) 653-0327 (TTY: 711), 7 days a week, 8:00 a.m. – 8:00 p.m. We can help you with this request. If you need a fast decision because of your health, you should call Member Services to ask for an expedited Fair Hearing.
After your hearing request is received by the HHSC Appeals Division, 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. During the hearing, you or your representative can tell the hearing officer why you need the service that we denied.
The HHSC Appeals Division will give you a final decision within 90 days from the date you asked for the hearing. If you qualify for an expedited Fair Hearing, the HHSC Appeals Division must give you an answer within 72 hours. However, if the HHSC Appeals Division needs to gather more information that may help you, it can take up to 14 more calendar days.