HealthSelect of Texas (ERS): the appeal steps in ERS's own guide

The Employees Retirement System of Texas (ERS) runs health coverage for Texas state employees. Its Summer 2025 guide sets out how appeals work for the active-employee medical plans. This page restates that guide. ERS says the plan's Master Benefit Plan Document governs if the two differ, and the denial letter's instructions come first.

Which plans

• HealthSelect of Texas, HealthSelect Out-of-State, HealthSelect Secondary and Consumer Directed HealthSelect. Blue Cross and Blue Shield of Texas (BCBSTX) administers them for ERS.
• TDI says it does not regulate state employee plans, so TDI's outside-review form is not the route here.

Step 1: the first-level appeal, with BCBSTX

• It starts with the instructions on the Explanation of Benefits. For a post-service claim, the appeal must be filed within 180 days of receiving the denial notice.
• The guide lists four routes: mail, fax, secure messaging in the member account, or a call to a BCBSTX Personal Health Assistant at 800-252-8039 (TTY 711). The mailing address in the guide is Blue Cross Blue Shield of Texas – Appeals, P.O. Box 660044, Dallas, TX 75266-0044.
• The guide asks for the name and ID number on the card, the provider's name, the date of service, the reason for disagreeing, and supporting papers such as a doctor's letter, a treatment plan and records.
• BCBSTX decides within 72 hours for an urgent request, 15 days for other requests before care, and 30 days for a post-service claim.

Step 2: the second-level appeal

• Before care (pre-service, urgent or concurrent): in writing to BCBSTX, within 60 days of receiving the first-level decision letter.
• After care (post-service): signed and in writing to ERS, within 90 days, by mail to Employees Retirement System of Texas, Appeals Administrator, PO Box 13207, Austin TX 78711-3207. ERS says these should not go to BCBSTX, as that may affect timeliness.
• ERS considers a post-service second-level appeal within 30 days of receiving it. It offers a scheduled call or a recorded statement.

Step 3: outside review by an independent review organization (IRO)

• Available after an unsuccessful second-level appeal that involves medical judgment, or whether the appeal steps were followed. It costs the participant nothing.
• The request must be received within four months of receiving the second-level denial. BCBSTX checks eligibility within five business days.
• More information can go to the IRO in writing within 10 business days of the IRO's notice. The IRO decides within 45 days. ERS says its decision is final and binding on all parties.
• Expedited: a written or verbal request when the doctor says the standard time would seriously jeopardize life, health or the ability to regain maximum function, and an expedited internal appeal has been filed. The IRO decides as fast as the condition requires, within 72 hours.

For scale

ERS reports that of 7.1 million HealthSelect of Texas claims processed in fiscal year 2024, 1,308 first-level appeals were filed with BCBSTX (0.0185% of claims), and 65 second-level appeals with ERS (0.0009%). These figures cover all kinds of care (ERS guide, Summer 2025).

Who reviews spine requests

Your denial letter names who reviewed the request. You can ask the plan for a free copy of the guideline the reviewer used.

Free public help

• BCBSTX Personal Health Assistant for HealthSelect, per ERS's guide: 800-252-8039 (TTY 711).
• ERS: the contact page at ers.texas.gov.
• Texas Department of Insurance, for help telling plan types apart: 800-252-3439.
• Office of Public Insurance Counsel (OPIC), the state office that speaks for insurance consumers: 1-877-611-6742.

What Denial Reply prepares

Denial Reply prepares appeal paperwork for Texas adults from the denial letter and records, with a calendar built from the steps and dates the letter gives. The free decoder at /decode needs no upload.

Related guides: which kind of plan you have · Texas outside review · asking for the claim file and criteria

Sources

• ERS, "ERS' Participant Guide to the Appeal Process: Active Employee Medical Plans" (Summer 2025): https://ers.texas.gov/group-benefits-program-gbp-insurance-plan-denied-claim-appeals/2025-sept-ers-participant-guide-to-the-appeal-process-active-employee-medical-plans (read 2026-11-03)
• TDI, "Getting help with a health plan that TDI doesn't regulate": https://www.tdi.texas.gov/consumer/getting-help-with-a-health-plan-that-tdi-doesnt-regulate.html (updated 12/17/2025; read 2026-11-03)