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Members

About Your Care

Doctor and Patient

We want to give you good care!

Molina Healthcare works with our providers to give you good health care. We look at your member benefits and make choices about care based on what you need. We want you to know:

  • We do not reward staff or other people to deny 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

 

If you have a concern about your health care, call Molina Member Services. If you call after our regular business hours, please leave a message and we will return your call within the next business day.

  • Our staff can accept collect calls
  • You can talk to our nurses about care choices and getting care through our 24-Hour Nurse Advice Line or 24-Hour Behavioral Health Crisis Line
  • A bilingual staff member or interpreter is available for members

 

Primary Care

See your primary care provider (PCP) for a health checkup. Many people wait until they are very sick to see a provider. You do not need to wait. Make sure you schedule a checkup before you get sick. This will help keep you well.

Specialty Care

A primary care provider (PCP) can handle most health care needs. But sometimes there are special problems such as a broken bone or heart disease. A visit to a provider who has extra training may be needed. This provider is called a specialist. If members need to see a specialist, their PCP will make sure they see the right one and may be able to help them get an appointment faster.

Out of Area Care

Routine care is not covered outside the Molina Healthcare service area, unless members are seen by a Molina Healthcare participating provider. If members need special care by a provider who is not part of the Molina Healthcare network, their PCP will help to get the authorization (approval) that is needed.

If members travel outside the service area, Molina Healthcare pays for emergency care. Members may go to a local emergency room (ER) or an urgent care clinic. Members need to tell them they are a Molina Healthcare member and show them their Molina Healthcare ID card. Remember that routine care is not covered outside the Molina Healthcare service area.

Out-of-Network Services

If a Molina Healthcare provider is unable to provide a member with necessary and covered services, Molina Healthcare must cover the needed services through an out-of-network provider. The cost to members should be no greater than it would be if the provider were in Molina Healthcare’s network. This must be done in a timely manner for as long as Molina Healthcare is unable to provide the service.

After Hours Care

There may be times when members need care and their primary care provider (PCP) is closed. If it is after hours and the PCP’s office is closed members can call Molina Healthcare’s 24-Hour Nurse Advice Line/Behavioral Health Crisis Line. Nurses are available to help you 24 hours a day, 7 days a week.

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 for members. If a member needs emergency care, they can call 911 or go to the nearest hospital. They do not need prior approval. If members have an urgent matter that does not threaten your life, they can also call Molina Healthcare’s 24-Hour Nurse Advice Line/Behavioral Health Crisis Line, 24 hours a day, 7 days a week. If you desire, there is also a Spanish Nurse Advice Line phone number.

Second Opinions

Members who do not agree with a provider’s plan of care have the right to a second opinion from another Molina Healthcare provider or from an out-of-network provider. This service is at no cost to the member.

Transition of Care

We care about your health and we want to ensure you get the care you need. If you have had health care services scheduled prior to joining Molina MyCare Ohio, it is important that you call Member Services today, or as soon as possible, so we can help you get the care you need. For a time after you join Molina MyCare Ohio, you may be able to continue to receive care from a provider that is not a network provider. This is called transition of care. Transition of care is important to ensure a smooth transition to our health plan and the benefits, services and prescriptions you need.

Transition of Care Time Period for Non-Waiver Members

Service Services you were receiving from a non-network provider at the time of your enrollment in the MyCare Ohio program will be covered from the first date of enrollment for:
  • Physician
  • Community Mental Health
  • Addiction Treatment Centers
365 days except if you are identified for high risk care management then your physician must be covered for 90 days.
Dialysis Treatment 90 days (or more if authorized by plan)
  • Ohio Medicaid Prior authorized Durable Medical Equipment, Vision and Dental
  • Scheduled Surgery
  • Chemotherapy/Radiation
  • Organ/Bone Marrow/Hematopoietic Stem Cell Transplant
Until the planned or authorized services are received.
Medicaid Home Health and Private Duty Nursing 90 days
Assisted Living or Medicaid Nursing Facility Unlimited period if lived in the facility on the day you enrolled in the MyCare Ohio program and the service continues to be medically necessary.

 

Transition of Care Time Period for Waiver Members

Service Services you were receiving from a non-network provider at the time of your enrollment in the MyCare Ohio program will be covered from the first date of enrollment for:
  • Physician
  • Community Mental Health
  • Addiction Treatment Centers
365 days except if you are identified for high risk care management then your physician must be covered for 90 days.
Dialysis Treatment 90 days (or more if authorized by plan)
  • Ohio Medicaid Prior authorized Durable Medical Equipment, Vision and Dental
  • Scheduled Surgery
  • Chemotherapy/Radiation
  • Organ/Bone Marrow Hematopoieticc Stem Cell Transplant
Until the planned or authorized services are received.
Medicaid Home Health and Private Duty Nursing 365 days unless a change is required due to a health or other life event that changes your needs.
Waiver Services - Direct Care including:
  • Personal Care
  • Waiver Nursing
  • Home Care Attendant
  • Choice Home Care Attendant
  • Out of Home Respite
  • Enhanced Community Living
  • Adult Day Health
  • Social Work Counseling
  • Independent Living Assistance
365 days unless a change is required due to a health or other life event that changes your needs.
All other waiver services 90 days and only after an in-home assessment is completed to transition your services to a new provider. (The services amount is maintained for 365 days)

Language Assistance

Members have the right to an interpreter. There is no cost. Members should tell the office staff if they would prefer to talk in their own language. If you need assistance, call Member Services.

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