Problems and Solutions

What to do and where to go to when you get stuck, either when applying for coverage, or when you need to get care.
Healthcare.gov: Income Changes, Cancelled Subsidies, Providing Documentation

We recommend when possible that consumers first seek help from their local in-person application assister. The healthcare.gov call center can also provide help for these issues.

Frequently Asked Questions about the Affordable Care Act

Texas Outreach and Enrollment Network FAQs

CLICK HERE TO ACCESS

The public Google drive includes printable pdfs of frequently asked question from enrollment assisters regarding eligibility and enrollment in Texas Medicaid, CHIP, and the Health Insurance Marketplace.

Programs:
General
Languages:
Tags:

Frequently Asked Questions about the Affordable Care Act

Kaiser Family Foundation Health Reform FAQs

The searchable collection includes nearly 300 up-to-date responses, answering new questions about plan renewal, cancellations, and continuing financial assistance. The FAQs also offer guidance for understanding 2014 federal income taxes in the context of the health law, addressing potential penalties for not obtaining coverage, exemptions to the individual mandate, and other subjects. Answers have been updated to key questions about the law and how it applies to people in different circumstances, including marketplace and Medicaid eligibility, and guidance for immigrants, people with variable incomes and others in special situations.

  • Online
Programs:
Marketplace, Marketplace / All, Medicaid, Obamacare
Languages:
English, Spanish

Trouble-shooting problems with healthcare.gov

I have a subsidy for health coverage, and my income has changed since I first enrolled.

It's important to report income changes as soon as you can, so you don't pay too much for your coverage, or have to pay a higher tax bill at the end of the year. Read about what to do at this link.

If you got local in-person help signing up for coverage, that same agency can help answer your questions about reporting income changes.

You can also call healthcare.gov 24 hours a day, 7 days a week.

  • In-Person
  • Online
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Trouble-shooting problems with healthcare.gov

Healthcare.gov says I have to provide more proof or documents, but I'm not sure what they need.

The best way to make sure you send in the right documents is to get help from:

The same agency that gave you in-person help signing up for coverage;

or call healthcare.gov (24 hours a day, 7 days a week).

  • In-Person
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Trouble-shooting problems with healthcare.gov

Healthcare.gov cancelled my subsidies and I got a bill from my insurance plan charging me the entire premium amount.

The best way to get help when subsidies are cancelled is from:

The same agency that gave you in-person help signing up for coverage;

or call healthcare.gov (24 hours a day, 7 days a week).

  • In-Person
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
Help from the Texas Department of Insurance

What can TDI Help With?

Things TDI may help you with:

TDI may be able to help you:

If your health plan's provider directory is not accurate;

If you need your health plan to help you find a doctor or other care provider;

If you think you have been charge for preventive care that should have been free.

Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

What can TDI Help With?

Filing a Complaint through TDI

You will likely need to talk to TDI's Consumer Help Line to find out if a formal complaint can be filed. If you need to file a complaint, you can do it online at this link.
  • Online
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

What can TDI Help With?

What to Do About "Surprise Bills"

At TDI's Health opptions website, look on the left-hand side for links on how to avoid Surprise Bills, and what to do if you get a Surpise Bill.
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

What can TDI Help With?

TDI "Your Health Care Coverage" Publication

This TDI publication provides an overview of types of health insurance and your rights. It is also available in Spanish.
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
Spanish

What can TDI Help With?

Some health plans are NOT regulated by TDI

TDI can help with issues for health insurance plans that are regulated by the State of Texas, which includes healthcare.gov, and any "individual" health policy you buy direct from an insurance company.

TDI does not regulate "self-insured" health plans: usually bigger companies. Also TDI does not regulate state, county, and city employee health plans.

Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
Insurance Problems: Finding a Doctor or Clinic, Unexpected Bills

Problems, Best Steps, and Who Can Help

Information on Surprise Medical Bills for People with HMOs

I have insurance, so why did I get a surprise medical bill?

CPPP partnered with MHP Salud out of the Rio Grande Valley to create a fact sheet which explains the rights of a consumer with insurance who receives a surprise medical bill. This can happen when they unknowingly received care from an out-of-network doctor or hospital during an emergency.

The fact sheet is meant to be used by any organization that helps consumers enroll in coverage or otherwise navigate the health system here in Texas. Thank you to MHP Salud for making it available in both English and Spanish. There is also a Word version of the document available that can be customized by replacing MHP Salud’s information with the logo and contact information of your organization.

If you have further questions about the flyer or consumer protections from surprise bills in Texas please contact Stacey Pogue, pogue@cppp.org.

  • Online
Programs:
Commercial Insurance, health insurance, Private Insurance
Languages:
English, Spanish

Trouble-shooting problems with your insurance plan.

Examples of Problems that come up with your health coverage.

Examples:

My doctor was listed in the provider directory when I signed up, but now won't take me as a patient/accept my insurance

I can't find a doctor who takes my plan

The doctor or clinic is in my health plan directory, but says they don't take "Obamacare"

I got a surprise bill from a doctor after an ER or hospital visit, even though the hospital was in my health plan's network

I got billed for a preventive care services that I thought would be free

Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Trouble-shooting problems with your insurance plan.

Best steps to take when these problems occur.

First, call the toll-free Customer Service number on your health insurance card.

If your insurer doesn't solve your problem and you had in-person assistance signing up for coverage, the assister agency where you signed up can help you with next steps.

  • In-Person
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Trouble-shooting problems with your insurance plan.

Texas Department of Insurance may also help.

The Texas Department of Insurance (TDI) can answer general insurance questions or help you file a complaint. Call the TDI Consumer Help Line or go to this web link.
  • Online
  • By Phone
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
Medicaid & CHIP Problems

Problems that can come up with a Medicaid or CHIP health plan, and steps to get the help you need.

Examples of Problems that come up with your Medicaid or CHIP health coverage.

Examples of Problems that come up with your Medicaid or CHIP health coverage.

My doctor (or other provider like a clinic or a therapist) was listed in the provider directory when I signed up but now won't accept my Medicaid or CHIP

I can't find a doctor (or other provider like a clinic or a therapist) who takes Medicaid or CHIP

Medicaid put the wrong "PCP" Doctor's name on my Card

Medicaid has the wrong address for me, or I need to update my address because I am moving

Programs:
CHIP, Medicaid
Languages:

Steps to take for Medicaid or CHIP health plan problems.

Step 1: Try calling your health plan first!

If you are already enrolled in a Medicaid Managed Care or CHIP health plan, call them first. There is a customer service number on your Medicaid or CHIP health plan ID card.
  • By Phone
Programs:
CHIP, Medicaid
Languages:
Tags:
Medicaid, CHIP

Steps to take for Medicaid or CHIP health plan problems.

Step 2: Texas HHSC Medicaid Managed Care Help Line

If you don't have a health plan card, or if your health plan does not fix your problem, you can call the Medicaid Managed Care helpline 1-866-566-8989.

The Texas HHSC Medicaid Managed Care Helpline helps people navigate the managed care system, understand their Medicaid coverage, understand their rights, and learn to advocate for themselves. They will help a consumer resolve problems, including access to care.

A priority is placed on individuals with urgent or complex health care needs.

  • By Phone
Programs:
CHIP, Medicaid
Languages:
Spanish, All-Translation

Steps to take for Medicaid or CHIP health plan problems.

Other Medicaid and CHIP problems: Texas HHSC Ombudsman

For other Medicaid or CHIP problems and issues, the HHSC Ombudsman offers help. If a normal complaint process cannot or does not satisfactorily resolve the issue, they will try to go the extra mile.

  • By Phone
Programs:
CHIP, Medicaid
Languages:
All-Translation, Spanish

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