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  • Ambetter Reconsideration Form Texas

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PROVIDER REQUEST FOR RECONSIDERATION AND CLAIM DISPUTE FORM. Use this form as part of the Ambetter from Superior Healthplan Request for .

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You have up to 180 days after date of the denial to request a Formal Appeal. Ambetter from Health Net's Appeals and Grievances Department will oversee the processing of your appeal.

You will need to present this card anytime you receive healthcare services. You should have received your Ambetter member ID card with your member welcome packet materials. If you don't get your member ID card before your coverage begins, call Member Services at 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989).

Service Areas. Ambetter plans are available in a select few states. These are Arkansas, Florida, Georgia, Mississippi, Illinois, Indiana, Massachusetts, New Hampshire, Ohio, Texas, Washington, and Wisconsin.

You can also reach us from 8am-8pm CST at 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989).

You can also reach us from 8am-8pm CST at 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989).

Ambetter from Superior HealthPlan is our new commercial HMO plan in the Texas Health Insurance Marketplace. Ambetter is not a Medicaid plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232