faq
CHIP Complaints and Appeals

What should I do if I have a complaint?

We want to help. If you have a complaint, please call us toll free at 1-855-691-6262 to speak to a Member Advocate.

You can also submit your complaint in writing to:

MCNA Dental
Attention: Member Advocate
4400 NW Loop 410, Suite 250
San Antonio, TX 78229

Can someone help me file my complaint?

Yes! An MCNA Member Advocate can help you file your complaint. Most of the time we can help you right away. Call 1-855-691-6262 to talk to an MCNA Member Advocate about your complaint. You may call at any time during the complaint process to check the status of your complaint.

Can I file a complaint with anyone else?

If you still wish to file a complaint after going through MCNA's process, you may file a complaint with the Texas Department of Insurance by phone at 1-800-252-3439, or by mail at:

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

What should I do if I have an appeal?

If you are not happy with MCNA's decision to deny or limit services requested by your dentist, please call us toll free at 1-855-691-6262 to speak to a Member Advocate.

You can also submit your appeal in writing to:

MCNA Dental
Attention: Member Advocate
4400 NW Loop 410, Suite 250
San Antonio, TX 78229

Can someone help me file my appeal?

Yes! An MCNA Member Advocate can help you file your appeal. Most of the time we can help you right away. Call the MCNA Member Hotline at 1-855-691-6262 to ask a Member Advocate for help filing an appeal. You may call the Member Hotline at any time during the appeal process to check the status of your appeal.

How quickly are appeals resolved?

Standard appeals are resolved within 30 days.

You can ask for an expedited appeal when you don't have time to wait for a standard appeal, such as when your child's life or health is in danger. Expedited appeals are resolved within 3 days. If MCNA decides your appeal does not meet the requirements to be expedited, your appeal will go through the standard appeal process.

Our Member Advocates will guide you through this entire process.

What if I'm still not happy?

You may file an appeal with the Texas Department of Insurance by phone at 1-800-252-3439, or by mail at:

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

You can also ask for an Independent Review Organization (IRO) to review your appeal.

What is an Independent Review Organization (IRO)?

An IRO is an organization that will review your appeal. They will decide if the services we denied or limited are medically necessary. The IRO has no connection to us or the decisions made by us to deny or limit services. They will make their decision based on certain rules. You can call the Texas Department of Insurance (TDI) at 1-866-554-4926 if you have any questions about the process.

To ask for an IRO, you can fill out the "Request for a Review by an IRO" form. This form was sent with the MCNA appeal decision letter. If we receive this form within 10 days, we will let the Texas Department of Insurance know of your request within 3 days. The IRO process then takes no longer than 20 days (or 8 days for emergency requests). The IRO will send you a notice of their decision. They will tell you what rules were using to make their decision and who was involved in making the decision.

Where can I find forms to use for a complaint or appeal?

Click here to download and print a complaint or appeal form.

Learn more about CHIP complaints and appeals in your Member Handbook.