Independent medical reviews in Illinois
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 calendar 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 free.
You may be able to have your services continue while your case is reviewed. To ask for continued services, call Molina Member Services at (855) 687-7861 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. Central Time.
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 30 calendar 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 Fair Hearing could harm your life, health, or ability to function, you, your provider, or your authorized representative can ask the Illinois Department of Healthcare and Family Services (HFS) for a fast (expedited) hearing. HFS must make a decision no later than three (3) business days after getting your complete case file from Molina Healthcare.
You can read more in your Member Handbook.
If you want to file a State Fair Hearing Appeal related to mental health services or items, substance abuse services, Persons with Disabilities Waiver services, Traumatic Brain Injury Waiver Services, HIV/AIDS Waiver Services, or any Home Services Program (HSP) service, send your request in writing to:
Illinois Department of Human Services
Bureau of Hearings
69 W. Washington Street, 49th Floor
Chicago, IL 60602
Fax: (312) 793-2005
Email: dhs.hspappeals@illinois.gov
Phone: (855) 418-4421, TTY: (800) 526-5812
You can file a State Fair Hearing in different ways. To ask for a State Hearing related to your medical services, you can:
Illinois Department of Healthcare and Family Services
Bureau of Administrative Hearings
69 W. Washington Street, 4th Floor
Chicago, IL 60602
To ask for a State Hearing related to your waiver services, you can:
Illinois Department of Human Services
Bureau of Administrative Hearings
69 W. Washington Street, 4th Floor
Chicago, IL 60602
If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Member Services at (855) 687-7861 (TTY, 711), Monday through Friday, 8 a.m. to 5 p.m. Central Time.
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 30 days from the date on the letter telling you the appeal decision.
You cannot file an EIR for appeals relating to waiver services.
You can read more in your Member Handbook.
Mail: Molina Healthcare of Illinois, Inc.
Attn: Member Appeals & Grievances
PO Box 182273
Chattanooga, TN 37422
Phone: (855) 687-7861
Fax: (855) 502-5128
You may call, fax, or write us for help:
Mail: Molina Healthcare of Illinois, Inc.
Attn: Appeals and Grievances
PO Box 182273
Chattanooga, TN 37422
You must ask for an EIR within 30 days of the date on the letter telling you the appeal decision.
You must ask for a State Fair Hearing within 30 days of the date on the letter telling you the appeal decision.
If you want both a State Hearing and an EIR, 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 EIR. In that situation, the State Fair Hearing decision is final.
You do not have to pay for a State Fair Hearing or an EIR.
You can read more about these rights in your Member Handbook.