MedStar Family Choice — Customer Service: Expert Guide for Members and Advocates

Overview of MedStar Family Choice customer service

MedStar Family Choice is a managed care plan serving Medicaid-eligible members in Maryland under the MedStar Health system. From a customer service perspective, the plan’s responsibilities include explaining benefits, helping members find primary care providers (PCPs), authorizing services when required, managing prior authorizations, and processing grievances and appeals. Members should expect customer service staff to be trained in enrollment rules, benefit coverage, transportation authorizations for non-emergency medical transportation (NEMT), and basic care coordination steps.

Customer service performance is regulated by both state Medicaid (Maryland Department of Health) and federal Centers for Medicare & Medicaid Services (CMS) standards. That means standard appeal timelines and acknowledgement windows apply: typically a standard appeal decision within 30 calendar days and an expedited decision within 72 hours when the member’s health would be jeopardized by waiting. These regulatory timeframes determine how customer service and the plan’s Grievance & Appeals unit should process your requests.

Primary contact methods and what works best

The fastest way to resolve routine questions is by calling the Member Services number shown on your MedStar Family Choice member ID card. If you do not have your card, use the plan’s official website to locate contact options — for example, visit medstarfamilychoice.com for current phone numbers, forms, and downloadable Member Handbooks. Written requests (secure online portal or mailed forms) are recommended when you need a permanent record, such as requesting prior authorization documentation or filing a formal appeal.

Expect multiple channels: phone (Member Services), a dedicated Grievance & Appeals unit, an online member portal (for claim status, authorization details, and secure messaging), and interpreter/TTY services for members with limited English proficiency or hearing impairments. For clinical questions after hours, many plans provide a 24/7 nurse advice line; ask Member Services for that phone number and the exact hours when you call.

What to prepare before you call

Preparation shortens call time and improves outcomes. Have your member ID number, date of birth, and provider name available. For authorization or billing disputes, have service dates, claim numbers (if provided), billing provider tax ID/NPI, and any denial letters. If a service was denied, keep printed or electronic copies of the denial, provider notes, and any prior authorization submissions from the provider.

Bring specific goals to the call: for example, “I am calling to request the status of a prior authorization submitted on June 12, 2024, for physical therapy; provider NPI 12-3456789; claim #987654321.” Specificity lets customer service look up event-driven tickets and provide a clear next step or escalation path.

• Document checklist to have on hand: Member ID number, date of service(s), provider name & NPI, claim or authorization numbers, written denial or explanation of benefits (EOB), and contact notes (date/time of prior calls and names of staff spoken to).
• When filing requests: use written forms from the plan website or secure portal to create an auditable trail; keep copies (PDF or paper) of everything you submit.

Grievances, appeals, and escalations — step-by-step

Start with Member Services for informal resolution. If the issue requires a formal challenge (denial of covered services, incorrect provider payment, or access problems), request a Grievance or Appeal packet from Member Services or download it from the plan website. File a grievance when you are dissatisfied with quality of care or service; file an appeal when you want to dispute a decision to deny, reduce, or terminate a service or benefit.

Timelines matter: under typical Medicaid-managed care rules, the plan must acknowledge appeals promptly and issue a standard decision within 30 days, or an expedited decision within 72 hours for urgent medical needs. If the plan does not resolve the appeal, you can request an external review or contact state-level resources (Maryland Department of Health) for further independent review. Keep all correspondence and note dates — these create the paper trail used in escalations.

Sample escalation script and documentation tips

Use a concise script when calling or writing. Start with identification and the action you want: “This is [Name], member ID [#]. I am calling to appeal a denial for [service] dated [date]. I request an expedited review due to [medical urgency]. Please confirm you received this appeal and provide a reference number.” Ask for expected response dates and the escalation contact if no response occurs.

After each call, immediately note the date/time, the representative’s name, and any reference/ticket number. If you file an appeal, follow up in writing and request confirmation of receipt and expected timeline. For urgent medical needs, request that the provider submit clinical justification with the appeal to support an expedited review.

• Escalation resources: start with Member Services → Grievance & Appeals → State Medicaid Managed Care Ombudsman (via health.maryland.gov) → CMS Regional Office for federal review. Use medstarfamilychoice.com for plan forms and medstarhealth.org for related provider resources.

Practical tips for advocates and providers

Providers should submit electronic prior authorizations and include clear ICD-10 diagnosis codes, supporting clinical notes, and objective measures (labs, imaging, functional scores). This reduces back-and-forth with customer service and expedites decisions. For complex authorizations, request a peer-to-peer review and have the treating clinician available to speak with the plan’s medical reviewer.

For member advocates: maintain a binder or encrypted folder containing every piece of correspondence, the member handbook (downloaded from the plan site), and a log of contacts. Track key statutory deadlines (e.g., 30-day appeal window) on a visible calendar. When multiple denials occur, escalate to the State Medicaid Ombudsman and include a chronological packet that documents the harm or risk to the member to support an external review.

What is the phone number for MedStar Family Choice?

833-895-0292. Representatives are trained to assist with any questions, concerns or inquiries about your medical plan coverage or available healthcare services.

Is MedStar a part of Johns Hopkins?

Established in conjunction with the Johns Hopkins University School of Medicine, our rehab program – as well as our orthopedic and rheumatology programs – are fast becoming the best in the country. July 1970 The operating room at MedStar Good Samaritan Hospital opens.

Is MedStar Family Choice DC Medicaid?

District of Columbia
MedStar Family Choice was awarded a contract as a Medicaid Managed Care Organization in September 2020.

How do I check the status of my MedStar Family Choice claim?

To obtain information on the status of your claims, please call our Claims Department at 800-261-3371. Our Claims Department is available Monday through Friday, 8:30 a.m. to 5 p.m. You may also check claims status online 24/7.

Does MedStar take Medicaid?

what insurance does MedStar accept? MedStar Health accepts a wide range of insurance plans, including: Medicare Medicaid Private health insurance plans TRICARE Workers’ compensation The specific insurance plans accepted may vary depending on the specific MedStar facility and the type of service being provided.

What type of insurance is MedStar Family Choice in Maryland?

MedStar Family Choice is a subsidiary of MedStar Health, the region’s largest healthcare provider. We are a provider-sponsored Managed Care Plan serving the District of Columbia and Maryland.