At Aetna Better Health of Texas, we believe in improving every life we touch as good stewards to those we serve.

In an Emergency

An emergency is when you have a very serious injury or illness. You may be hurt badly, or bleeding heavily. You might be feeling very bad pain or feeling very, very sick. If you don’t get help, you may have permanent damage to a body part or you could even die.

Go to the nearest hospital or call 911 right away when:

• You are afraid you may be dying
• You are badly hurt
• You have very bad chest pains
• You may be poisoned
• You may have taken an overdose of medicine
• You are choking or having problems breathing
• You may have a broken bone
• You have diarrhea or vomiting that won’t stop
• You are bleeding heavily
• You  are badly burned
• You fainted
• You suddenly can’t move (paralysis)
• You are a victim of a violent attack (rape, mugging, stab or gunshot wound)
• You have thoughts of causing harm to yourself or others
• You are about to deliver a baby

For many illnesses, you don’t need to go to the emergency room.  If you have a cold, a cough or a rash, you can call your doctor. It’s the same if you have small cuts or bruises. You don’t need to go to the hospital.  If you’re unsure, you can call our nurse line. The nurse can help you decide if you need to go to the emergency room.

Nurse line - you can talk to a nurse when you have health questions. You can call the nurse line 24 hours a day, 7 days a week.

You can call the nurse line at:
Medicaid STAR 1-800-248-7767 (Bexar), 1-800-306-8612 (Tarrant) STAR Kids 1-844 STRKIDS (1-844-787-5437) CHIP or CHIP Perinate  1-866-818-0959 (Bexar), 1-800-245-5380 (Tarrant)
TTY/TDD - 1-800-735-2989 
If you have an emergency, please call 911.
For members who are deaf or hard of hearing, you can call us toll-free at 1-800-735-2989.

If you feel that you can wait to seek care, you can call your primary care provider.

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Aetna complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Aetna does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
Aetna:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print,  paper, audio, accessible electronic formats, other formats) at no cost.
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card or 1-800-385-4104.

For financial Literacy information see the Office of Consumer Credit Commission webpage https://occc.texas.gov/consumers/consumer-education/guide

How to request a fair hearing

A Fair Hearing can be requested within 150 days from the appeal decision letter. The Appeal denial notification includes a Fair Hearing Request Form (English/Spanish) for the member to complete and send to the health plan.

In the instance the MCO does not make a decision on an appeal within the 60-calendar day timeframe, the member may request a state fair hearing within 150 days from the date that is 60 days after the appeal request date.

Procedures for requesting a fair hearing

If a member or as the parent or guardian of a member of the health plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a signed authorization letter to the health plan telling them:

• The representative’s name
• The representative’s title
• The representative’s agency
• The representative’s address
• The representative’s phone number

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 150 calendar days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 150 calendar days, you may lose your right to a fair hearing. To ask for a fair hearing, you or your representative should either send a letter to the health plan at: Aetna Better Health Attention: Member Advocate P.O. Box 569150 Dallas, TX 75356-9150 or call 1‑844‑STRKIDS (1‑844‑787‑5437 (STAR Kids) 1-800-306-8612 (STAR for Tarrant) or 1‑800‑248‑7767 (STAR for Bexar) and by fax (877-223-4580). If you do not request a fair hearing by this date, the service the health plan denied will be stopped. 

You have the right to continue to receive services the health plan denied or reduced, at least until the final hearing decision if member requests a state fair hearing within: (1) 30 calendar days from Aetna Better Health’s mailing of the Notice of Action.  The member may be required to pay the cost of services furnished while the appeal is pending if the final decision is adverse to the member.  A decision on a state fair hearing will be made in 120 days (for State Fair Hearing Requests through June 2020). 

Phone number for oral requests for a fair hearing

STAR: 1-800-248-7767 (Bexar County)

STAR: 1-800-306-8612 (Tarrant County)

STAR Kids: 1-844-787-5437

Mailing address for written requests for a fair hearing

Aetna Better Health                              

Attn: Member Advocate                        

P O Box 569150                                        

Dallas, TX 75356-9150       

Phone: 1-800-248-7767 (Bexar County)

Phone: 1-800-306-8612 (Tarrant County)

Phone: 1-844-787-5437

Contact numbers

Contact number: Toll-free number to request an Appeal:

STAR - 1-800-248-7767 (Bexar County)

STAR - 1-800-306-8612 (Tarrant County)

STAR Kids - 1-844-787-5437