Frequently Asked Questions (FAQ)
Below are some frequently asked questions. If you have any other questions or need help, please contact Cigna-HealthSpring Member Services at 1-877-653-0327 (TTY: 7-1-1) Monday to Friday, 8 a.m. to 5 p.m. Central Time.
If you would like to change your primary care provider, just call Cigna-HealthSpring Member Services at 1-877-653-0327 (TTY: 7-1-1). and tell us. If you do not already have a primary care provider, we will help you find one and make an appointment.
If you ask to change your primary care provider, the change will take place on the next business day after the request. A new Cigna-HealthSpring ID card will be mailed to you within five business days of your call. The actual delivery time is based on the US Postal Service.
Service Coordinators do just that: they help you coordinate your services and care. You and your Service Coordinator will work together to figure out your health needs. You will also work together to create a service plan, coordinate your services and care, and then monitor your progress toward your health care goals. Depending upon your needs, your Service Coordinator may be a registered nurse, licensed vocational nurse or a social worker.
You can contact the Service Coordination team by phone with questions or concerns: Call toll free at 1-877-725-2688 (TTY: 7-1-1).
Your Service Coordinator will:
- Call you and get to know you and your health care, long-term care, and behavioral health needs
- Use a health risk assessment to help decide if you need more help right away
- Talk with any case managers, doctors, pharmacists, or other persons that you tell us are important for your care
- Help you find the services you need in your community
- Write a service plan with you, along with help from your family and your primary care provider
The following services and support benefits are available to members who meet specific criteria:
- Day activity and health services
- Personal assistance services
The following home and community-based services are available to certain members as medically necessary:
- Adaptive aids and medical equipment
- Adult foster care
- Assisted living services
- Cognitive rehabilitation therapy
- Day activity and health services
- Dental services
- Emergency response services
- Employment assistance and supported employment services
- Employment assistance helps people find paid employment in the community
- Supported employment helps a person stay employed in a workplace where there are non-disabled workers
- Financial management services (formerly consumer directed services)
- Home delivered meals
- Medical supplies not available under the Texas Medicaid State Plan/1915(b) Waiver
- Minor home modifications
- Nursing services (in home)
- Personal assistance services
- Respite care services
- Physical, occupational, and speech therapies
- Transition assistance services
How do I get these services?
You and your Service Coordinator will complete a health risk assessment that helps to identify services that meet your health care needs. Some of these services may include those services in the list above. If you are eligible for these services and the service is medically necessary, you will work with your Cigna-HealthSpring Service Coordinator and main doctor to get services in place.
If you do not have a car or cannot get a ride for a medical visit, you can call the Medical Transportation Program for a ride at 1-877-633-8747 (TTY: 7-1-1). This program will help you get to a doctor’s visit for the care you need.
Please note: this program is not for emergencies. If you have an emergency and cannot get a ride, call 911.
When you call the Medical Transportation Program, tell them why you need a ride, if you need help during the ride (like a wheelchair), and give them all of your Medicaid information. If you need help with setting up a ride, call Member Services. They will make the call with you.
You should call for a ride as soon as you make your medical appointment. For routine medical care, you need to call at least two days before your visit. If you have a visit outside of the county you live in, you will need to call at least five days before your visit. The sooner you call, the better.
The following outpatient substance abuse services are available:
- Detoxification services
- Counseling treatment
- Medication-assisted therapy
The following residential substance abuse services are available:
- Detoxification services
- Substance use disorder treatment (including room and board)
- Mental health rehabilitative services that reduce a member’s disability resulting from severe mental illness and serious emotional, behavioral or mental disorders
- Targeted case management services that assist members with getting access to needed medical, social, educational, and other services and supports
Behavioral health refers to the care and treatment of members with:
- Mental health concerns
- Drugs or alcohol dependence
How do I get non-emergency help if I have mental health or substance abuse concerns?
For routine help, call the behavioral health line at 1-877-725-2539 (TTY: 7-1-1). Cigna-HealthSpring covers medically necessary mental health and substance abuse care.
How do I get emergency help for mental health or substance abuse concerns?
If you have a behavioral health crisis, you can get help by calling the mental health crisis line at 1-800-959-4941 (TTY: 7-1-1). Qualified mental health professionals are ready 24 hours a day to:
- Answer your questions
- Assess your mental health
- Provide and coordinate services you need
- Speak with you in English or Spanish
- Speak with you in other languages when you ask
Do I need a referral for this?
No, a referral from your primary care provider is not necessary to receive mental health and substance abuse services.
If you have a life threatening emergency or an emergency that poses a threat to the lives of others or property, call 911 or go directly to the nearest emergency room.
A specialist is a doctor who treats specific health problems, like a heart doctor, a skin doctor, or a bone doctor. Your PCP can help you decide when you need to see a specialist.
You can see a Cigna-HealthSpring OB/GYN, an eye doctor, a dentist, a mental health doctor, or go to family planning services without talking to your PCP.
Can I call the Health Information Line at any time? What kinds of things can the nurses help me with?
You can talk to a Cigna-HealthSpring experienced registered nurse 24 hours a day, 365 days a year. Our nurses offer immediate, reliable information for any health concern. Please call 1-855-418-4552 (TTY: 7-1-1). Help is ready in English or Spanish.
When you visit your doctor, have lab tests done, go to the emergency room or urgent care center, or receive long-term care services, you must bring the following:
- Your valid Cigna-HealthSpring ID card, valid picture ID card and either:
- Your Texas Benefits Medicaid Card, or
- Your Medicaid temporary verification form (Medicaid Form 1027 A).
- Health and Medical Records (If available)
If you are not in the hospital, you can change your health plan by calling the Texas STAR or STAR+PLUS Program Helpline at 1-877-782-6440 (TTY: 7-1-1). You can change health plans as many times as you want, but not more than once a month. If you are in the hospital, you will not be able to change health plans until you have been discharged.
If you call to change your health plan on or before the 15th of the month, the change will take place on the first day of the next month. If you call after the 15th of the month, the change will take place the first day of the second month after that. For example:
- If you call on or before April 15, your change will take place on May 1.
- If you call after April 15, your change will take place on June 1.
Your doctors must provide help to you if you have limited English speaking or reading skills.
If your doctor is unable to get an interpreter for you, they may contact Cigna-HealthSpring for help by calling the provider Hotline at 1-877-653-0331 (TTY: 7-1-1).
If you are age 18 and older, family planning services such as birth control and counseling are private. You don’t need to ask your Primary Care Provider to get these services. The Texas Women’s Health Program offers family planning services that fit the way you live. You can go to any family planning provider who takes Medicaid. We can help you find the care you need. Please call 1-877-653-0327 (TTY: 7-1-1).
If you have Medicare coverage in addition to STAR+PLUS (Medicaid), your Medicare coverage will be your primary coverage. This means that your Medicare coverage is always the first insurance to be used. STAR+PLUS (Medicaid) will not change your Medicare coverage.
If you lose Medicaid coverage but get it back again within six (6) months you will get your Medicaid services from the same health plan you had before losing your Medicaid coverage. You will also have the same primary care provider.
If you or an authorized representative wishes to file an appeal or complaint you may call Cigna-HealthSpring Member Services at 1-877-653-0327 (TTY:7-1-1), Monday to Friday, 8 a.m. to 5 p.m. Central Time, excluding state-approved holidays. If the call is after hours, please leave a message and your call will be returned within one business day.
To file an appeal or complaint for services other than those involving Prescription Drugs/Pharmacy, you can fax your Expedited Appeal to 1-877-809-0783 or mail your request to:
Attention: Appeals and Complaints Department
PO Box 211088
Bedford, TX 76095
To file an appeal or complaint for services involving Prescription Drugs/Pharmacy, you can fax your Expedited Appeal to 1-866-766-6405. Or you can write us and send your request to:
Attention: STAR+PLUS Appeals
PO Box 24207
Nashville, TN 37202