Tools and Resources
Find all important documents and forms below:
Member Resources and Information
Transition of Care
For enrollees new to BSWHP who are in active treatment for medical conditions with non-BSWHP network providers, BSWHP may grant up to 90 days to transition care from non-BSWHP providers to BSWHP providers, based on individual case review.
Please fill out the Transition of Care form and either submit it to BSWHP at:
Baylor Scott & White Health Plan
1206 W. Campus Drive
Temple, TX 76502
Attention: Member Relations
Baylor Scott & White Health Plan doesn't require members to select a primary care physician (PCP). You have the flexibility of using any of our network providers. However, if you choose to select a PCP, you can. In fact, everyone on your plan can select their own PCP.
All claims are processed at the Baylor Scott & White Health Plan headquarters in Temple, Texas. When a Baylor Scott & White Health Plan member is covered by more than one insurance or medical plan, we coordinate benefits paid by BSWHP to avoid duplicate coverage and payment. A copy of the other insurance Explanation of Benefits (EOB) must accompany any claims submitted to Baylor Scott & White Health Plan for secondary coverage determination.
Subrogation refers to cases when another person or insurance company is responsible for payment of medical services. Injuries on someone else's premises and motor vehicle accidents are the most common examples. Baylor Scott & White Health Plan expects to be reimbursed for expenses paid for care if a third party is responsible.
Bratton Firm acts as our representative in subrogation claims. If Baylor Scott & White Health Plan has already paid medical expenses, Bratton Firm will investigate. For questions regarding possible subrogation claims, please contact Bratton Firm at 512.477.8772.
Injuries related to on-the-job circumstances should be filed directly with the Workers Compensation carrier or the employer involved. Baylor Scott & White Health Plan does not pay for work-related injuries.
More Claims Information
For questions related to claims issues, including claims submissions, payments, denials and adjustments, call us at a href="tel:+18446335325">844.633.5325 and ask for the claims department.
Appeals and Grievances
Baylor Scott & White Health Plan recognizes that an enrollee, physician, provider or other person designated to act on behalf of an enrollee may encounter an event in which performance under this agreement does not meet expectations. It is important that such an event be brought to our attention. We are dedicated to addressing problems quickly, managing the delivery of health care services effectively and preventing future complaints or appeals.
The Medical Director of the Baylor Scott & White Health Plan has overall responsibility for the coordination of the complaint and appeal procedure. Download the complete Baylor Scott & White Health Plan Complaint and Appeal Procedure.