The Texas Department of Insurance has created this web page to serve the needs of pharmacists and pharmacy staff. This page represents one component of TDI's Pharmacy Outreach Initiative and provides information detailing how TDI can assist pharmacists in understanding insurance and HMO coverage, workers' compensation coverage, and requirements for claims processing and payment.
Complaints to TDI
TDI can help pharmacists with complaints on a variety of issues including complaints regarding prompt and correct payment of health care claims. Note: Complaints concerning transaction or claim processing fees must include the name of the carrier; the patient's name, patient's group and ID numbers, and the name of the PBM, if any.
For information on filing an insurance-related complaint, visit our Online Complaint Portal or call the Consumer Help Line at 800-252-3439 between 8 a.m. and 5 p.m., Central time, Monday-Friday. Pharmacists can also send TDI an email or letter that includes:
- the pharmacist/pharmacy contact information;
- the name of the health plan and/or PBM involved in the complaint;
- the nature of the complaint; and
- patient name(s), group and ID number(s), and date(s) of service.
Resources
Division of Workers' Compensation - Pharmacy Closed Formulary Rules