Molina Healthcare works with your providers to give you good health care. We make choices about your care based on what you need. We also look at your benefits. We do not reward providers to deny you care. We also do not reward staff or other people to deny you care or give you less care. We do not pay extra money to providers or our staff members to deny tests or treatments that you need to get better or stay healthy.

You may call our Member Services team if you ever have a concern about your health care. You can also talk to our nurses about getting needed care. Our nurse staff is here to take your call Monday through Friday (except holidays) during normal business hours. They can answer questions about how we make health care choices.

We also want to remind you that Molina Healthcare has a Nurse Advice Line to help answer questions you may have about your health. There are nurses ready to help you 24 hours a day, 7 days a week. To speak to a nurse, call the toll-free number below.

^*Printed copies of information posted on our website are available upon request.

1. Where do I get care?

You should get all health care from Molina Healthcare providers. These are providers who have a contract with Molina Healthcare. Your Provider Directory lists them all. It also lists other places you can go. You can get care at some approved offices like:

• Health centers
• Rural health clinics
• Family planning providers.
• Community mental health centers

These should be Medicaid providers. We update the Provider Directory quarterly (every three months) and mail it to you when you are first enrolled and upon request. It tells you where you can get health care. If you get routine care from a provider who does not have a contract with Molina Healthcare, you may have to pay for that care. In an emergency you can see any provider. It does not need to be a Molina Healthcare provider.

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2. How do I change my Primary Care Provider (PCP)?

• The Provider Directory (link to POD) has a list of Molina Healthcare PCP’s.
• You can select a new PCP and call Member Services to notify us

Molina Healthcare will send you a new ID card with the provider’s name. The card also lists the effective date of the change.

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3. How do I obtain interpreter services?

You have a right to an interpreter. There is no cost to you. Tell the office staff if you would prefer to talk in your own language. If you need help, call Member Services.

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4. Why do I need a Referral or Authorization?

A “Referral” means you go somewhere else besides your regular PCP for service. Referrals may be written or by phone. Some services must be approved by your PCP or Molina Healthcare. This is called an “Authorization”. Your PCP will take care of any referrals you need.

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5. Who can I call with questions, concerns or complaints?

Our Member Services Department is available to assist you. Call us at 866-449-6849, 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 (English) or 866-648-3537 (Spanish). A registered nurse can answer any question you may have regarding your health care.

Please remember that you may also speak to your PCP about your medical concerns. Your PCP and his/her staff are there to help.

If you need further assistance, you may also contact Molina Healthcare's Ombudsman Unit at 888-665-4621. An Ombudsman is someone who can help you if you are not satisfied with the help you received from Molina Healthcare Member Services.

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6. How does Molina Healthcare look at new services?

We also look at new services. And we look at new uses for benefits you have now. We review new studies to see if services should be added to your benefit package. Molina Healthcare reviews the type of services listed below at least once a year:

• Medical services
• Mental health services
• Medicines
• Equipment

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7. How do I get behavioral health services?

Access to Behavioral Health Services
Molina Healthcare wants you to have the help you need. We can help you get behavioral health services. We can find you help for drug and alcohol abuse. Call Molina Healthcare Member Services for information.

• Providers
• Nurses
• Psychologists
• Social workers

These providers are trained to help you with psychiatric and emotional problems.

• Inpatient
• Outpatient hospital services
• Psychiatric provider services
• Individual, family, and group therapy
• Treatment provided by a psychiatrist or behavioral health provider
• Social rehabilitation
• Day treatment for adults and children
• Individual and family assessments

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8. When do I get my new member handbook and ID card?

You should receive your Member Handbook and Molina Healthcare ID Card the first or second week after your enrollment is effective with Molina Healthcare.

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9. What if I need a dentist?

As a Molina Healthcare member, you have access to dental services. If you need dental services, you may get care from any dentist listed in the Provider Directory. You may also contact Member Services for help finding a dentist.

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10. What if I need vision care?

As a member of Molina Healthcare, you have access to vision care. To find the vision care provider nearest you, please look in the Vision Section of your Provider Directory. You can also contact Member Services for help. You do not need a referral from your PCP for routine vision care.

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11. How can I get specialty care?

You should be able to get an appointment with a Specialist as follows:

• Within 21 days for non urgent specialty care
• Within 24 hours for urgent care, but care that does not threaten your life. This is care that can be done in a provider’s office

Please contact us if you cannot get an appointment when you need one. Call us at 866-449-6849 for help. Don’t forget to bring your State Medicaid card with you to all of your provider’s visits. Also, be sure to bring your Molina Healthcare member ID card with you as well. Please be on time so that you can be seen as scheduled.

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12. What do I do if I am out of my area and need to see a provider?

When you travel away from your hometown, Molina Healthcare pays for emergency care for you. You may go to a local emergency room (ER) or an urgent care clinic. Tell them you are a Molina Healthcare member. Show them your Molina Healthcare ID card. Routine care, such as normal provider visits or pre-planned surgery, is not covered outside of your service area.

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13. How do I make an appointment?

You should be able to get an appointment with your Primary Care Provider (PCP) as follows:

• Within 14 days for routine, non-urgent care
• Within 60 days for school physicals
• Within 24 hours for urgent care, but care that does not threaten your life. This is care that can be done in a provider’s office

Please contact us if you cannot get an appointment when you need one. Call us at 866-449-6849 for help. Don’t forget to bring your State Medicaid card with you to all of your provider’s visits. Also, be sure to bring your Molina Healthcare member ID card with you as well. Please be on time so that you can be seen as scheduled.

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14. What do I do if my provider’s office is closed?

There may be times when you may need care and your Primary Care Provider (PCP) is closed. If it is after hours and your PCP’s office is closed you can call your PCP or Molina Healthcare’s Nurse Advice Line. Nurses are available to help you at any time of the day. Call 888-275-8750, 24 hours a day, 7 days a week.

Molina Healthcare’s Nurse Advice Line has highly trained nurses. They can help you decide if you or your child should see a provider right away. The nurses can also help you make an appointment if you need to see a provider quickly. Sometimes, you have questions but you do not think you need to see your PCP. You can call the Nurse Advice Line and talk to a nurse. They will help you.

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15. What if I need emergency care?

Emergency care is for sudden or severe problems that need care right away. It can also be care that is needed if your life or health is in danger. Emergency care is a covered benefit. If you need emergency care, call 911 or go to the nearest hospital. You do not need prior approval. If you have an urgent matter that does not threaten your life, you can also call Molina Healthcare’s Nurse Advice Line. Highly trained nurses are available to help you at any time of the day. Call 888-275-8750, 24 hours a day, 7 days a week.

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