Appeals and grievances in New Mexico

As a Molina member, you have the right to file a complaint (grievance) if you have a problem with your medical care or our services. Some examples are:

• The care you get from your provider
• The time it takes to get an appointment or see a provider
• The providers you can choose for care

An appeal can be filed when you do not agree with our decision to:

• Stop, change, suspend, reduce, or deny a service
• Deny payment for services provided

To file an appeal or grievance, you can:

• Call Molina at (888) 295-7651 (TTY:711), Monday through Friday, 8 a.m. to 6 p.m. local time. We will try to help you over the phone.
• Fill out the Member Grievance Form, which is included with the notice of initial denial adverse determination and mail it to: Molina Healthcare of New Mexico Grievance and Appeals Unit PO Box 182273 Chattanooga, TN 37422 Fax: (505) 342-0583
• Log in to the My Molina member portal 

We will send you a letter acknowledging receipt of your appeal or grievance within three business days and issue a formal response within 30 calendar days.

You can also call the Managed Health Care Bureau (MHCB) Office of Superintendent of Insurance (OSI) at (855) 427-5674 or (505) 827-4601 for help at any time.

For more information, check your member handbook  or your agreement and evidence of coverage.

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