Your Medicaid grievances and appeals in South Carolina

If you have a problem with your care or our services, you can file a complaint. At Molina, a complaint is called a grievance. A grievance is used when you are unhappy about something other than a benefits decision. You can file a grievance at any time.

Examples of grievances include:

• You can’t find a doctor
• You have trouble getting an appointment
• Someone at Molina or a doctor’s office treats you unfairly

Appeals

You can file an appeal when you do not agree with a decision we made about your benefits. This is also called an adverse benefit decision. You may appeal decisions such as:

• Services that are denied or limited
• Services that are reduced, stopped, or ended
• Payment for services that is denied
• Services that are not provided on time
• Appeals or grievances not handled on time
• A request to go outside the Molina network in a rural area
• A decision about costs you must pay, like premiums or copays

 
How to file a grievance or appeal:

You can file a grievance or appeal in any of these ways:

• Phone. Call Member Services at (855) 882-3901 (TTY:711) Monday to Friday 8 a.m. – 8 p.m. local time
• Mail.  Fill out a grievance or appeal form and mail it to:
  
  Molina Healthcare of South Carolina
  c/o Firstsource
  PO Box 182273
  Chattanooga, TN 37422
  
  
• Fax. Fill out a grievance or appeal form and fax it to (877) 823-5961, Attn: Member Appeals & Grievances.
• In person visit. You can come to our office at 115 Fairchild Street, Suite 340, Daniel Island, SC 29492
• Electronically through the My Molina member portal

 
What to include in a letter
If you send a letter, please include:

• The date
• Your first and last name
• Your address and phone number
• Your email address
• Your Molina member ID number (on the front of your member ID card)
• Description of the issue
• Your signature

Help from someone else

You may ask a family member or your doctor to file for you. To do this, we need your written permission. You may use this form to give your permission for grievances.

Grievance Consent Form.

Approved representatives must have your written permission to file an appeal for you. You may use this form to give your permission.

Appeal Consent Form 

 
Learn more

For more details, please read your Member Handbook.