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Members

Looking at what’s new in technology to improve our service to you

Doctor running a test on a girl

Molina Healthcare uses a medical review process to rate:

  • A new drug
  • Medical device
  • Medical rule or procedure
  • Surgical rule or procedure
  • Behavioral health rule or procedure
  • Therapy

 

We want to make sure that it is safe. We also want to know if it is good for a medical symptom or condition. It is compared to cures. The goals of this process are:

  • To review and update coverage choices as new scientific proofs are found.
  • To review cases in order to decide if it is or not a certain service we should cover.

Molina Healthcare may deny a drug, device, protocol, procedure or other therapy that is new. We might say it is not medically necessary. If this happens, you can ask us why. You or your doctor can ask for this information. You can have copies of all the rules and procedures we used to make the decision. For information on this process, call Member Services.

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This information is for Doctors and
Health Care Professionals only.

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