Appeals and grievances in Texas

Appeals and grievances

As a Molina Healthcare 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 Healthcare at (888) 560-2025 (TTY:711), Monday through Friday, 8:00 a.m. to 6:00 p.m. local time. We will try to help you over the phone.

Fill out the Member Grievance Form and mail it to: Molina Healthcare of Texas, Inc., Attn: Member Complaints and Appeals, P.O. Box 182273, Chattanooga, TN 37422. Or fax it to (877) 816-6416.

• Log in to the My Molina Member Portal

We will send you a letter acknowledging receipt of your appeal or grievance within 5 calendar days and issue a formal response within 30 calendar days.

You can also call the Texas Department of Insurance (TDI) at (800) 252-3439 for help at any time.

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

Read your Member Handbook

Your handbook explains covered services, programs, rewards and how to use your benefits. Keep it handy when you need care.

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