Who May Make a RequestYour prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your representative. Contact us to learn how to name a representative.
This form may be sent to us by mail or fax:
P.O. Box 31397
Tampa, FL 33631
Expedited appeal requests can be made by phone at:
TexanPlus HMO (Houston/ Beaumont)
TexanPlus HMO (Dallas/ Ft. Worth)