Questions? Call 1-888-665-4621.
1. Who can I call with questions, concerns or complaints?
2. Can I change my primary care doctor
3. I have a long standing relationship with my physician that is not in your network. How do I get him/her added?
4. Why do I need a primary care doctor?
5. When will I receive my Medi-Cal Program welcome packet?
6. Who is eligible to enroll with Molina Healthcare?
7. What do I do if I need a dentist?
8. Does Molina offer transportation? How do I request it?
9. How can I obtain specialty care?
10. How do I file a grievance?
11. What do I do if I am out of my service area and need to see a doctor?
12. What type of service is available when you are away from Molina Healthcare's service area?
1. Who can I call with questions, concerns or complaints?
Our Member Services Department is available to assist you. Call us at 888-665-4621, Monday through Friday, 7:00 a.m. to 7:00 p.m. Our staff is bilingual and can answer any question that you may have in regards to your health plan benefits.
Molina Healthcare also has a 24-hour Nurse Advice Line that you may call toll-free at 888-275-8750 or TTY/TDD 866-735-2929 (for the deaf or hard of hearing). A registered nurse can answer any question you may have regarding your health care.
Please remember that you may also speak to your primary care doctor about your medical concerns. Your primary care doctor and his/her staff are there to help.
If you need further assistance, you may also contact Molina Healthcare's Ombudsman Unit at 888-665-4627. An Ombudsman is someone who can help you if you are not satisfied with the help you received from Molina Healthcare Member Services.
The California Department of Managed Health Care is responsible for regulating health care services plans. If you have a grievance against your health plan, you should first telephone your health plan at 888-665-4621, and use your health plan's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than thirty (30) days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll free telephone number (888-HMO-2219) and a TTD line (877-688-9891) for the hearing and speech impaired. The department's Internet website www.hmohelp.ca.gov has complaint forms, IMR applications forms and instructions online.
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2. Can I change my Primary Care Doctor?
Yes. As a member of the Medi-Cal Program through Molina Healthcare, we want you to be comfortable with your assigned primary care doctor. You may change your primary care doctor by calling our Member Services Department at 888-665-4621. Or you may complete a "Change of Primary Care Doctor" form at your primary care doctor's office and have the staff fax us the form at 562-901-9632.
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3. I have a long standing relationship with my physician that is not in your network. How do I get him/her added?
Please call our Member Services Department, Monday through Friday from 7:00 a.m. to 7:00 p.m., at 888-665-4621. Deaf or hard of hearing members may call our toll-free TTY number at (800) 479-3310. You may also contact us by calling the California Relay Service at 711.
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4. Why do I need a Primary Care Doctor?
Molina Healthcare wants to make sure that you get the best quality care and Service. This is why a Primary Care Doctor is assigned to you. This Primary Care Doctor will be your own personal doctor. Molina Healthcare has a large group of doctors for you to choose from. Chances are that your doctor may already be with Molina Healthcare. Your Primary Care Doctor will be responsible for all of your medical care and for referring you to other doctors when needed.
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5. When will I receive my Medi-Cal Program Welcome Packet?
You will receive a Welcome Packet prior to your effective date of coverage.
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6. Who is eligible to enroll with Molina Healthcare?
Eligible Medi-Cal Beneficiaries who live in Los Angeles, Riverside, San Bernardino, San Diego, and Sacramento may join. If you live in one of these counties, but are not sure if you can enroll with Molina Healthcare, contact Health Care Options (HCO) at 800-430-4263 or your eligibility worker.
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7. What do I do if I need a dentist?
If you need dental services, you may get care from any dentist who accepts Denti-Cal. You will need your white Beneficiary Identification card (BIC) in order to receive services. Molina Healthcare does not offer dental services, but when dental services need to be done in a hospital, your dentist will need to contact Molina Healthcare to arrange services. For the name of the nearest dentist in your area, you may call 1-800-DENTIST (800-336-8478).
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8. Does Molina Healthcare offer transportation?
Emergency transportation is available to you in life threatening situations. You may call 911 directly and an ambulance will be sent to you. Please remember that ambulances are for life threatening emergencies only and should not be used for routine medical care. You may be responsible for services if you use an ambulance for non-emergency conditions.
For routine medical appointments or non-urgent medical care, Molina Healthcare's Member Services Department can help you get transportation. They have a list of community resources that offer public or low-cost transportation. Call them toll-free at 888-665-4621.
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9. How can I obtain specialty care?
All specialty care, except for the services listed below, must be scheduled for you by your primary care doctor. Your primary care doctor is responsible for making sure that you receive the necessary medical care services.
You do not need your primary care doctor to schedule these services:
- Emergency services or out-of-area Urgent Care Services
- Nurse midwife services
- Female members may also self-refer to an OB/GYN who is in their PCP’s network.
- Family Planning Services
- HIV Testing & Counseling Minor Consent Services
- Sexually transmitted diseases
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10. How do I file a grievance?
If you have a problem with any Molina Healthcare services, we want to help fix them. You can call any of the following toll-free for help:
- Call Molina Healthcare toll-free at (888) 665-4621, Monday through Friday, 7:00 a.m. - 7:00 p.m. Deaf or hard of hearing members may call our toll-free TTY number at (800) 479-3310. You may also contact us by calling the California Relay Service at 711.
- Call the Medi-Cal Ombudsman toll-free at (888) 452-8609.
- Call the California State Department of Managed Health Care (DHMC) toll-free at (888) HMO-2219 (888-466-2219) or TDD (877) 688-9891.
- Call Health Care Options toll-free at (800) 430-4263 to change plans.
- File a request for a Medi-Cal Fair Hearing by calling toll-free (800) 952-5253 or TDD (800) 952-8349.
- You may also send us your problem or complaint in writing. Our address is:
Molina Healthcare
Member Services Department-Grievance and Appeals Unit
200 Oceangate, Suite 100
Long Beach, California 90802
Grievance forms are in the office of each primary care provider (doctor). These forms can also be downloaded and printed from Molina’s website at www.molinahealthcare.com/medicaid/members/ca/quality/griev_form.html. You may also send us your problem or complaint online. The website address is www.molinahealthcare.com.
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11. What do I do if I am out of my service area and need to see a doctor?
In case of a life-threatening emergency, go to the nearest hospital or call 911 immediately. For urgent cases, you may telephone our 24-hour nurse help line at 888-275-8750.
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12. What type of care is available when you are away from Molina Healthcare's service area?
Molina Healthcare provides coverage for emergency or urgent care when you are away from our service area. Go to the nearest emergency room for care. Please contact Molina Healthcare within 24 hours or when medically reasonable of getting emergency care.
Please contact Molina Healthcare's Member Services Department at 888-665-4621, Monday to Friday, from 7:00 a.m. to 7:00 p.m.. Our toll free number for the deaf or hard of hearing is 800-479-3310. Outside of regular business hours you may contact our Nurse Advice Line day or night at 888-275-8750.
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