Guidelines for Appealing a
Medical Denial

You have the right to appeal when we deny (turn down) a request for medical services. You have up to 30 days to file an appeal.

• You do this by contacting us directly and telling us you want to appeal.
  • If you call on the phone, you will need to follow up with a letter within 5 days. Please send any written appeals to:

Molina Healthcare Appeals Department
7050 S. Union Park Center
Suite #200
Midvale, UT 84047

• You may arrange to come here in person. Please call 1-888-483-0760, extension 170456, to make an appointment.
• You may call Molina Healthcare on the telephone at 1-888-483-0760.
• If you want your doctor to do an appeal for you, you will need to give him or her your permission in writing.
• You may have someone represent you, including an attorney.
• An “expedited” appeal is available if your health care provider (doctor) feels the situation needs attention right away.
  • This kind of appeal will be completed quickly and no more than 72 hours after the request is received. The appeal will be completed sooner depending on your condition.
  • You can ask for an expedited appeal by telephone. Your doctor will need to send us a fax or give us a phone call telling us why it is urgent.
  • You and your physician will be notified immediately when we make our decision.
• When you make an appeal, you can expect the following to happen:
  • If you want help, you will get help filling out forms or doing other things to finish your appeal.
  • You will get a letter or a phone call to tell you we have received your appeal and when we received it.
  • You will have a chance to send us any information you want us to look at about your appeal.
  • A medical doctor who knows about the kind of health condition you have will review your appeal.
  • Your appeal will be resolved, and we will notify you within 30 days.
  • You may ask us in writing to see your appeal case file, and we will make arrangements for you to do that.
• When your appeal is about services you were getting but that were ended or decreased, you can keep getting the services during the appeal if all of the following happens:
  • You or your provider files the appeal within 10 days of the date we mailed the notice to you about the above benefit changes, and
  • the service was ordered by a provider authorized by Molina Healthcare of Utah, and
  • it is still within the service period that it was authorized originally, and
  • you request the benefit to continue.
• If you meet all of the above areas, your benefit will be continued until one of the following happens:
  • You withdraw the appeal, or
  • 10 days pass after Molina Healthcare of Utah sends you a letter telling you the appeal decision, or
  • the State Fair Hearing Officer turns down your appeal, or
  • the original authorization runs out.
• If the appeal does not change our decision to deny services, you may have to pay for the care you received during the appeal process.
• If Molina Healthcare or the State Fair Hearing Officer does change the first decision, Molina Healthcare of Utah will cover the cost of your care.