Texas CHIP Plan

Sendero participates in the Children's Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P). CHIP is a health insurance plan for children under the age of 19 and is designed for families who earn too much money to qualify for Texas Medicaid programs, yet cannot afford to buy private insurance. CHIP-P provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid.
Click here to Learn more about Texas CHIP and Cost-Sharing

Texas STAR Plan

Sendero participates in the State of Texas Access Reform (STAR) Managed Care Program (Medicaid). As a part of Medicaid, Sendero provides both Children’s Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.
Click here to Learn more about the Texas STAR plan

  

Member Information

Member Services 1-844-872-0537, M – F 8 AM – 5 PM.

For hearing impaired: 7-1-1 (TTY). Interpreter Services also available.

These are a few important things about your and your child’s health care:

  You will receive a Sendero ID Card, if you have not already received one.
  Your Primary Care Provider’s (PCP) name will be on the Sendero ID Card.
Please check the ID Card to make sure the names on it are correct.
  Get to know you and your child’s doctor. Make an appointment with your PCP as soon as possible.
  Call your PCP for appointments. Tell them you and your child are Sendero STAR or CHIP Members.
  Call your PCP whenever you or your child needs health care.
  Follow your PCP’s advice.
  Carry your Sendero ID Card(s) and Your Texas Benefits Medicaid Card(s) with you at all times.

Use the hospital emergency room only for emergencies.

If there is an emergency or crisis, go to the ER or call 9-1-1.

Please feel free to call or write us if you have any questions. We have special services for people who have trouble reading, hearing, seeing, or speak a language other than English or Spanish. If you need information in a different language, in audio form, larger print, or Braille, let us know and we will get it to you. Just call Sendero Member Services at 1-844-872-0537 as soon as possible. Sendero will give these materials to you at no cost.

Order or Replace your Sendero Health Plans ID Card
Call Sendero’s Member Services Department at 1-844-872-0537 anytime Monday through Friday 8- 5 pm, and request a new identification card. We will mail you your new identification card the next day.

Prescription, Vision, and Dental Benefits Information

  • Prescription Benefits
    For prescription benefit questions contact Sendero Member Services Toll-free at
    1-844-872-0537
    https://www.navitus.com

  • To lookup a specific drug click here.

  • Vision Benefits
    Sendero Health Plans partners with OptiCare/Envolve to cover your routine eye exams. Routine eye exams may include tests, examinations or dilation to:

    1. See the inside, outside and surrounding areas of your eyes
    2. Measure the pressure of your eyes
    3. Evaluate how well you see objects—up close and at a distance
    4. Determine if you need a prescription for glasses or contact lenses
    5. Detect diseases or conditions

    1. Click here to Visit the Opticare/Envolve General Provider Locator tool
    2. Click "Search by Zip Code"
    3. Enter your Zip Code, then choose your plan "IdealCare by Sendero Health Plans" from the "Select Health Plan" drop-down menu.
    4. Click "Search"

  • Value-Added Dental Services for Sendero Members over 21:
    Up to $500 of dental services for pregnant women

  • DentaQuest - Toll-free at 1.800.516.0165
    https://www.dentaquest.com/tx

24-Hour Nurse Help Line

1-855-880-7019
TDD: 7-1-1
24 hours a day, 7 days a week

Call the Nurse Help line before going to the emergency room, unless it is an emergency. A nurse will answer your health care questions and help the Member get the care they need.

Information is available in English and Spanish. Call us to get an interpreter.
In case of an emergency, call 9-1-1 or go to the nearest hospital.

How can I Access Behavioral Health or Substance Abuse Services?

Beacon Health Options
Sendero STAR: 1-888-287-5402
Sendero CHIP: 1-888-287-5403
https://www.beaconhealthoptions.com
24 hours a day, 7 days a week

Information is available in English and Spanish. Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. This includes assessment, counseling, and treatment services. Services provided by a licensed psychologist, licensed professional counselor, licensed master’s social worker, advanced clinical practitioner or licensed marriage and family therapist are not covered for Members 21 years and older. You do not need a referral for behavioral (mental) health services or drug and alcohol treatment.

Translation Services

If you need to speak to a Customer Service Representatives to about your benefits, how to get care, or any other questions or concerns. We have bilingual Customer Service Representatives that can help you. Our Customer Service Representatives speak English and Spanish. We also offer over the phone interpreters in other languages. When you call us, you can ask to talk to someone in the language you speak. The services are free. If you need help with your benefits or have questions on how to get care or services please call us.

If you need face-to-face interpreter assistance for your doctor’s appointments, call Sendero Customer Service toll-free at 1-844-872-0537. For face-to-face services you will have to call at least 48 hours before your appointment.

How To File A Complaint and / or Complaint Appeal

For detailed instructions click here.

How to file an Appeal for Benefit Denial or Reduction

For detailed instructions click here.

Availability of Material in Alternate Formats

Information is available in English and Spanish. Call us to get an interpreter. Information can also be made available in audio, large print, Braille or other languages, if needed.

Call our Member Services Department at 1-844-872-0537 anytime Monday through Friday between 8 - 5 pm to ask for these special services or if you have any questions about the Member Handbook.

State Fair Hearing Information

If you disagree with Sendero’s decision, you have the right to ask for a State Fair Hearing from the Health and Human Services Commission (HHSC). You may represent yourself at the fair hearing, or name someone else to be your representative. This could be a doctor, relative, friend, lawyer, or any other person. You may name someone to represent you by writing a letter to Sendero Health Plans telling them the name of the person that you want to represent you.

You or your representative must ask for a State Fair Hearing within 120 days from the date on the Sendero appeal decision letter. If you do not ask for the fair hearing by this date, you may lose your right to a fair hearing. You also have the right to request a State Fair Hearing if Sendero does not make a decision on your appeal request within the required timeframe. To ask for a fair hearing, you or your representative should write or call Sendero at:

Sendero Health Plans
Attn: Appeals
2028 E. Ben White Blvd., Ste. 400
Austin, Texas 78741
Toll-free phone: 1-855-297-9191
For hearing impaired, call 7-1-1 (TTY)
Fax: 512-901-9724

If you believe that waiting for a fair hearing will put your life or health at risk you or your representative may ask for an expedited fair hearing by writing or calling Sendero. To qualify for an expedited fair hearing through HHSC, you must first complete Sendero’s internal appeals process.

If you ask for a fair hearing within 10 days after the date of the appeal decision letter you may be able to keep getting any service or benefit that is being terminated, suspended, or reduced by Sendero, at least until the final hearing decision is made. If you do not request a fair hearing by this date, the service or benefit will be terminated, suspended, or reduced. If you lose your fair hearing appeal, Sendero may be able to recover the costs of providing the service or benefit to you while the appeal was pending. 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 hearings are held by telephone. You can also contact the HHSC hearings officer if you would like the hearing to be held in-person. During the hearing, you or your representative can tell why you need the service or why you disagree with the Sendero’s action.

You have the right to examine, at a reasonable time before the date of the fair hearing, the contents of your case file and any documents to be used by Sendero at the hearing.

Before the hearing, Sendero will send you all of the documents to be used at the hearing.

HHSC will give you a final decision within 90 days from the date you asked for the hearing.

Member Advisory Group

Would you like to get more involved with your health plan? Sendero is looking for members to join the Member Advisory Committee. This committee will give Sendero ideas and feedback from a member’s point of view. Call us toll-free at 1-844-872-0537 to learn more.

Provider Services and Provider Relations Contact Information

Monday through Friday 8 AM - 5 PM

For more information on joining the Sendero network, please email us at providers@senderohealth.com or click here to download a provider interest form.

You may also call our Network Management team at 1-855-895-0475.

Email providers@senderohealth.com to request an in-office training by a Sendero Provider Representative. Please include in the request any special topics that you would like more information about from Sendero.