Texas: Start Here
Beginner guide for Texas—HealthCare.gov, TDI IRO review, Ch. 4201 PA gold carding & UR appeals.
Read guideState playbook
Texas
State insurers, legislation, and appeal resources for patients and advocates in Texas.
4 guides
Texas Prior Authorization Law
§ 4201.653 gold carding—90% over 12 months; 3-day adverse notice; Rx immediate IRO.
Read guideTexas Health Insurance Appeals and Grievances
Ch. 4201—30-day UR appeals, 1-day expedited, skip-internal for life-threatening & Rx.
Read guideTexas Independent Review (TDI / IRO)
Binding on plan—LHL009 to carrier; 20-day standard / 3-day urgent IRO; free to members.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of Texas
- Ambetter from Superior HealthPlan
- Molina Healthcare of Texas
- Oscar Health (Texas)
- Cigna Healthcare (Texas)
- UnitedHealthcare (Texas)
- Community Health Choice (Houston area)
- HealthCare.gov (Texas Marketplace)
- Texas Medicaid (HHSC)
External appeals
After internal appeal, for eligible Texas fully insured plans only.
- TDI — independent review (IRO)
- Medicaid — HHSC fair hearing