What is a denial? A denial means Molina Healthcare is telling a provider and you that services will not be rendered or paid for. If we deny your service, you have the right to request why your services were denied. This right is called an appeal

If your service is denied, you will get a letter from Molina Healthcare telling you about this decision. This letter, called an Adverse Action, will tell you about your right to appeal. You can also read about these rights in your Member Handbook.

A member advocate can also help you file an appeal. If you are not happy with the result of your appeal, you can ask for a second level review. This means doctors outside Molina Healthcare review all the facts in your case and make a decision. We will accept that finding. You can also appeal your case to the State of Texas. This is called a Fair Hearing. This is also outlined in the member handbook

Would you like to ask for a review of an appeal? Please call us toll-free at 1-866-449-6849 (TTY (English) 1-800-735-2989, (Spanish) 1-800-662-4954), to tell us about your problem. A Molina Member Service Advocate can help you file an appeal; just call your Member Advocate at 713-418-1999, Extension 204016 if you are in the Houston area or 210-366-6500, Extension 203011 if you are in the San Antonio area and ask them to help set this up for you.