What You Need to Know About Grievances and Appeals

Are you having problems with your medical care or our services? If so, you have the right to file a grievance or appeal.

A grievance can be for things such as:

• the care a member gets from his or her doctor or hospital
• the time it takes to get an appointment or be seen by a doctor
• doctor availability in a member’s area.

An appeal can be filed when you do not agree with Molina Healthcare’s decision to stop, change, suspend, reduce, or deny a service. You also can file an appeal when payment for services is denied, which may make you responsible for the bill.

You also may ask for a Fair Hearing through the New Mexico Human Services Department (HSD) Fair Hearings Bureau.

Go online and check our website, www.molinahealthcare.com, or your Member Handbook to read about:

• grievance, appeal, and Fair Hearing processes and rights
• grievance, appeal, and Fair Hearing timeframes
• who can file a grievance or appeal.