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?

If you are not happy with MCNA's decision to deny your appeal based on medical necessity, you can request review of your case by an Independent Review Organization (IRO). You can mail, fax, or email your written request to:

MCNA Dental
ATTN: Grievance and Appeals Department — CHIP IRO Request
4400 NW Loop 410, Suite 250
San Antonio, Texas 78229

Fax: 1-954-628-3330
Email: ga@mcna.net

An MCNA representative can help you with your request.

What is an Independent Review Organization (IRO)?

An Independent Review Organization (IRO) is an organization that will review your appeal and 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. We must pay the cost of the external review conducted by IRO. MCNA must abide by the IRO's decision and carry out its instructions. You can call our Member Hotline toll-free at 1-855-691-6262 if you have any questions about the independent review 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. You will have 120 days from the day you get our decision letter to send the form back to us. If you do not file your request for an external independent review with 120 days, it cannot be reviewed.

When we get your completed form, we will tell the IRO about your request within 3 days. If you need help filling out the IRO form, please call our Member Hotline toll-free at 1-855-691-6262. An MCNA representative will be happy to help you.

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.