How To File A Complaint

How do I file a complaint with Sendero and can someone from Sendero help me?
If you have a complaint, please call us toll-free at 1-844-872-0537 for help. A Sendero Member Services Advocate can help you file a complaint. Most of the time, we can help you right away or at the most within a few days.

If I am not satisfied with the outcome, what else can I do?
You may file an appeal if you are not happy with our answer to your complaint. Your doctor may also file an appeal for you. To appeal, call Sendero Member Services at 1-844-872-0537. They will explain how to appeal the complaint. Click on How to File an Appeal on the Home Page to learn more.

FOR CHIP Members

What are the requirements and time frames for filing a complaint?
You can make a complaint at any time. If you need help filing a complaint, Sendero can help. Call 1-844-872-0537 for help. We will send you a letter and a form to complete. This letter will be mailed within five (5) business days after your telephone call. You must complete the complaint form and send it back to us.

How long will it take to process my complaint?
We will send you a letter to let you know we received the complaint. This letter will be sent within five (5) days of receiving your complaint. We will send you a form to complete and mail to us. We will not follow-up on your complaint unless you put it in writing. We will not punish you for filing a complaint. Your doctor may file a complaint for you. We will not punish you/your doctor for filing a complaint. Most of the time, we can help you right away or at the most within a few days. At the most, we will respond with an answer to your complaint within thirty (30) days of receipt. If you are not happy with the way we help you, you can call us and appeal. Sendero wants to help you get the best healthcare for your family. If you have questions about how to file a complaint, an appeal, or need additional help, call us toll-free at 1-844-872-0537. We will be glad to help.

Call us:  Sendero Health Plans
Member Services
1-844-872-0537

Write to us:   Sendero Health Plans
ATTN: Member Advocate
2028 E. Ben White Blvd., Suite 400
Austin, Texas 78741


All complaints are reviewed to make sure that there is follow-up. They are also reviewed to make sure that timely answers are given.

Do I have the right to meet with a Complaints Appeal Panel?
You also have the right to meet with a Complaints Appeal Panel. This panel is made up of doctors and others who will hear your complaint and make a decision.

If I am not satisfied with the outcome, who else can I contact?
If you are not satisfied with the answer to your complaint, you can also complain to the Texas Department of Insurance by calling toll-free to 1-800-252-3439.

If you would like to make your request in writing send it to:

Texas Department of Insurance
Consumer Protection
P.O. Box 149091
Austin, Texas 78714-9091

If you can get on the Internet, you can send your complaint in an email to http://www.tdi.texas.gov/consumer/complfrm.html

If I want my appeal reviewed by an Independent Review Organization (IRO) (CHIP Members Only)

An Independent Review Organization is an organization that the Texas Department of Insurance (TDI) selects to review appeals for health plans. When a member or doctor is not happy with the health plan response, TDI will help make a decision through this organization.

If you are not happy with the results of the Sendero appeal, fill out IRO form that was sent to you with the denial letter. You must return the form to Sendero. Member Services or the Member Advocate can help you fill out this form. We will send your request to TDI right away. To request a review by an Independent Review Organization, call Sendero at 1-844-872-0537. Complete the IRO form obtained from Sendero and mail it to us at:

Sendero Health Plans
Attn: Health Service Department
2028 E. Ben White Blvd., Suite 510
Austin, TX 78741

What are the time frames for this process?
TDI will arrange for an Independent Review Organization (IRO) to review your appeal within one (1) business day after they receive the request. TDI will let you and Sendero know who the IRO is. Sendero will send all of your records on your case to the IRO no later than the third working day after your request for an IRO. The IRO will make a decision about the service within fifteen (15) days. Sendero will follow the IRO decision.

FOR Medicaid (STAR) Members

If I have Medicaid (STAR), How do I file a complaint with the State (Health & Human Services Commission)?
If you get benefits through Medicaid’s STAR, STAR+PLUS, or STAR Health program, call your medical or dental plan first. If you don’t get the help you need there, you should do one of the following:

Phone:Call Medicaid Managed Care Helpline at 1.866.566.8989 (toll-free)
 
Online: Click here for Online Submission Form (only works in Internet Explorer)
 
Mail: Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247
Fax: 1.888.780.8099 (Toll-Free)

You may also ask for a Fair Hearing. Click on State Fair Hearing information on the Home Page to learn more.