Independent medical reviews in Arizona

Overview

If you or an authorized representative asked for an appeal and got a resolution letter saying our decision stayed the same, you can ask for an external appeal if you do not agree.

You can also ask for an external appeal if you asked for an appeal, did not get a resolution letter and more than 30 days have passed since you filed your appeal.

You can ask for a State Fair Hearing. You may also be able to ask for an External Independent Review (EIR).

External appeals are no cost.

You may be able to keep getting services while your case is reviewed. To ask for continued services, call Molina Member Services at (800) 424-5891 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. local time.

State Fair Hearing

A State Fair Hearing lets a judge who is not part of Molina Healthcare review your case.

You must ask for a State Fair Hearing within 120 days from the date on the letter that tells you the appeal decision. The judge’s decision is final, and we must follow it.

If waiting for a State Fair Hearing could harm your life, health or ability to function, you, your provider or your authorized representative can ask the Arizona Department of Insurance & Financial Institutions (DIFI) for a fast (expedited) hearing. DIFI must make a decision no later than 3 business days after getting your complete case file from Molina Healthcare.

You can read more in your Member Handbook.

How can you ask for a State Fair Hearing?

You can file a State Fair Hearing send a letter to:

Molina Healthcare
Attn: Appeals and Grievances Department/SFH
5055 E Washington St, Suite 210
Phoenix, AZ 85034

If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Member Services at (800) 424-5891 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. local time

External Independent Review (EIR)

An EIR lets an independent doctor who is not part of Molina Healthcare review your case. Their decision is final, and we must follow it.

You must ask for an EIR within 6 months from the date on the letter telling you the appeal decision.

You can read more in your Member Handbook.

How can you ask for an External Independent Review (EIR)?

You can call the Arizona Department of Insurance and Financial Institutions (DIFI) to ask for an IMR/EIR.

Toll-free: (800) 325-2548, (TTY 711) You can also get the IMR/Complaint Form and learn more at: https://difi.az.gov/file-complaint

Important Timeframes

You must ask for an EIR within 6 months from the date on the letter telling you the appeal decision.

You only have 120 days to ask for a State Hearing.

If you want both a State Hearing and an EIR, ask as soon as you can.

Important: If you first ask for a State Hearing and the hearing already happened, you cannot ask for an EIR. In that situation, the State Hearing decision is final.

Cost

You do not have to pay for a State Hearing or an EIR.

You can read more about these rights in your Member Handbook.