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Members

About Your Care

Doctor and patient talking
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 providers to deny care
  • 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

 

Members who have a concern about their health care can call Member Services at (800) 869-7165/ TTY 7-1-1.

  • Our staff is here to take calls Monday to Friday 8 a.m. – 5 p.m. (except holidays). If you call after 5 p.m. or over the weekend, you can leave a message and your phone number. Our staff will return the call, within no more than one business day.
  • There are nurses you can talk to about your health care choices and getting the needed care available through our Nurse Advice 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 and your children 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 you need to see a specialist, your PCP will make sure you see the right one and may be able to help you get an appointment faster.

Out of Area Care

If you are away from Molina Healthcare’s service area and need emergency care, go to the nearest emergency room. Please contact Molina Healthcare within 24 hours or when medically reasonable of getting urgent or emergency care. Call toll-free (800) 869-7165. If you are deaf or hard of hearing, call the national TTY line toll-free 7-1-1. When you are away from Molina Healthcare’s service area, only urgent or emergency care is covered. No services are covered for Medicaid members outside the United States.  Emergency services are covered for Basic Health members outside of the United States.

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

Urgent care services are available when you are within or outside of Molina Healthcare’s service area. However, no services are covered outside the United States for Medicaid members. Urgent care services is treatment needed right away, but your life is not in danger.

Sometimes you or your child gets ill after hours. If you can, wait until the next day when your PCP’s office is open. You can also call our Nurse Advice Line toll-free (888) 275-8750. Our nurses can help you any time of the day or night. They will tell you what to do or where to go to be seen. You can also ask your PCP the name of the urgent care center you can go to. It is best to find out ahead of time. Ask your PCP the name of the urgent care center and hospital you can use.

Emergency Care

Emergency care is available 24 hours a day, 7 days a week for Molina Healthcare members.

Emergency care is for a sudden or severe health problem that needs care right away. It can also be care that is needed because you believe your life or health is in danger.

If you think you have an emergency:

  • Call 911 right away.
  • Go to the closest hospital or emergency room.

 

When you go for emergency care, carry your Molina Healthcare Member ID Card.

If you are not sure if you need emergency care, call your PCP or call our 24-hour Nurse Advice Line toll-free (888) 275-8750. The Nurse Advice Line is staffed by registered nurses (RNs). You can call the Nurse Advice Line 24 hours a day, 7 days a week.

Hospital emergency rooms are only for real emergencies. These are not good places to get non-emergency care. They are often very busy and must care first for those whose lives are in danger. Please do not go to a hospital emergency room if your condition is not an emergency.

Second Opinions

If you do not agree with a provider’s plan of care you have the right to a second opinion from another Molina Healthcare provider or from an out-of-network provider.

Language Assistance

Members have a right to an interpreter. There is no cost. Members can tell their provider they prefer to talk in their own language. They can call Member Services for help at (800) 869-7165/ TTY 7-1-1.

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