Independent Medical Reviews in Idaho
Learn about your rights to file an external appeal.
If you or an authorized representative asked for an appeal and got a resolution letter saying our decision stayed the same — and you do not agree — you have the right to ask for an external appeal. You or an authorized representative can also ask for an external appeal, if you asked for an appeal but 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.
External Appeals are at no cost to you.
You may be able to have your services continue while your case is reviewed. To ask for continued services, call Molina Member Services at (844) 809-8445 (TTY: 711), Monday through Friday, 8:00 a.m. to 6:00 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 telling you the appeal decision. The judge’s decision is final, and we must follow it.
If waiting for a State Hearing could harm your life, health, or ability to function, you, your provider, or your authorized representative can ask the Idaho Department of Health and Welfare (IDHW) for a fast (expedited) hearing. IDHW 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 in different ways
Administrative Procedures Section
Idaho Department of Health and Welfare
450 West State Street 10th Floor
PO Box 83720
Boise, ID 83720-0036
If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Member Services at (844) 809-8445 (TTY: 711), Monday through Friday, 8:00 a.m. to 6:00 p.m. local time.
Important Timeframes
You must ask for a State Fair Hearing within 120 of the date on the letter telling you the appeal decision.
Cost
You do not have to pay for a State Fair Hearing
You can read more about these rights in your Member Handbook.