Independent medical reviews in California

Independent medical review (IMR)

If you asked for an appeal and got a letter saying our decision stayed the same — and you do not agree — you have the right to ask for an external appeal. You can ask for an independent medical review (IMR). You must ask for one within 180 days from the date of the Notice of Appeal Resolution letter.

An IMR gives you a chance to have your case reviewed by an independent doctor who is not part of Molina Healthcare. The doctor’s decision is final, and we must follow it.

Review your Member Handbook for more information on your rights.

Medicaid

Medicare

IFP

How do I ask for an IMR?

The California Department of Managed Health Care (DMHC) regulates health care service plans. If you have a grievance against your health plan, you should first use Molina’s grievance process before contacting DMHC. Call Molina at (888) 665-4621 (TTY:711) Monday through Friday, 7 a.m. to 7 p.m. local time.

Contact DMHC if you need help with a grievance that:

• Involves an emergency
• Has not been satisfactorily resolved by Molina
• Has remained unresolved for more than 30 days

You can call them at (888) 466-2219 or (877) 688-9891 TDD. Their website has complaint forms, IMR application forms and instructions.

Important timeframes

You must ask for an IMR within six months (180 days) from the date on the letter telling you the appeal decision.

You only have 120 days to ask for a State Fair Hearing. If you want both a State Hearing and an IMR, ask as soon as you can.

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

Cost

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

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

Medicaid

Medicare

IFP