Coverage decisions about your healthcare
A coverage decision about your healthcare is a decision about:
- Your benefits and covered services, or
- The amount we will pay for your healthcare services.
Coverage decisions about your drugs
A coverage decision about your drugs is a decision about:
- Your benefits and covered drugs, or
- The amount we will pay for your drugs.
This applies to your Part D drugs, Texas Medicaid prescription drugs, and Texas
Medicaid over-the-counter drugs.
You can ask someone to represent you when you ask for a coverage decision. An appointed representative can be:
- A relative
- A friend
- An advocate
- A doctor
Fill out the Appointment of Representative form in English or Spanish to have someone act on your behalf.