Members Tips

Your Primary Care Provider (PCP) is the doctor you see on a regular basis. You do not have to go to the emergency room for basic medical care. Make sure you see your PCP at least once a year for preventive care. Seeing your doctor for regular checkups may help to find problems early enough to fix them. When you sign up with Superior, you are asked to choose a PCP. If you need to choose or change your PCP, call Superior Member Services. More information on how to choose a PCP can also be found in your member handbook.

Did you know you can talk to a nurse 24 hours a day? Superior’s nurse advice line is a toll-free health information line. They can help you with:

  • Medical advice.
  • Answer questions about your health.
  • Advice about a sick child.
  • Information about pregnancy.

To reach a nurse, call Superior Member Services.

Superior HealthPlan does not reward or pay our doctors or employees for approving or denying utilization reviews. Decisions are based on appropriate care and coverage.

Do you have a question about whether or not a service is covered by Superior? Our Utilization Management (UM) Department checks to see if the service needed is a covered benefit. If covered, the UM nurses check to see if the service is medically necessary by reviewing the medical notes and talking with your doctor. If the service is medically necessary, Superior approves the service.

If you are moving due to farm work, it is still important for your child to get the medical and dental care they need to stay healthy. Children of Traveling Farm Workers can usually get their checkup sooner. If you are leaving the area to follow work, call Member Services to get help scheduling an appointment.

Do you need a ride to your doctor’s appointment? Medicaid members should call the Medical Transportation Program at 1-877-633-8747 (1-877-MED-TRIP). Call at least two work days before you need to be picked up.

Superior wants you to have timely, appropriate care for all your health needs. You should be able to get an appointment scheduled with your Primary Care Provider (PCP) as follows:

  • Urgent care visit within twenty-four (24) hours.
  • Routine care visit within fourteen (14) days.
  • Preventive health service visits within three (3) months for an adult and two (2) months for a child.

Please call Member Services if you need help making an appointment with your PCP.

You should always carry your/your child’s Superior Member ID card with you. You’ll need this for doctor’s appointments or when picking up medications. If you change your name, need to pick a new Primary Care Provider (PCP) or your Superior Member ID card is lost or stolen, please call Superior Member Services. You will get a new Superior Member ID card.

Superior has experienced nurses who can help you understand problems you may have, like asthma, diabetes, using the emergency room frequently or being in the hospital often. We work with your doctor to keep you healthy. Call Member Services and ask for a Case Manager if you need help managing your health.

Superior has staff members who speak English and Spanish. If you speak another language, need materials in braille or are hearing impaired, please call Superior Member Services.

We know change can be scary. Superior HealthPlan wants to make this change easy. Whether you are new to Texas Medicaid managed care or are changing health plans, we will make sure you continue to get the services you need.

One of the most common obstacles to switching Medicaid plans is maintaining your relationship with the physicians that know you best. Our staff will work with you and your doctors to continue any services you are receiving, even if the doctor is not in our network.

It is important to let us know right away if you will need the services you are getting to continue. That way, we can provide you with the right information to keep getting the health care you need on our Medicaid managed care plans or so that we can assist you with transitioning to a new provider.

We will honor authorized services up to ninety (90) days. After that time we may require authorization for the service. We will let you stay with an out-of-network doctor for up to ninety (90) days. In some cases you may be able to keep your out-of-network doctor for a longer period of time. We will help you find a doctor in our network that can provide the services you need. Our Case Managers can help get your medical records transferred to your new doctor. Call our Member Services department toll-free if you have questions about transitioning your care.