Independent medical reviews in Washington

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.You may also be able to ask for an Independent Medical Review (IMR).

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 (800) 869-7165, Monday through Friday, 7:30 a.m. to 6:30 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 Office of Administrative Hearings (OAH)for a fast (expedited) hearing. OAH 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

• Contact the Office of Administrative Hearings (OAH) directly at (800) 583-8271, or
• Write to them at:
  PO Box 42489
  Olympia, WA 98504-2489

If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Molina Member Services (800) 869-7165, Monday through Friday, 7:30 a.m. to 6:30 p.m. local time

Independent Medical Review (IMR)

An IMR 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 IMR within 21 calendar days of receiving your State Fair Hearing Decision if you do not agree with it.

You can read more in your Member Handbook.

How can you ask for an Independent Medical Review (IMR)?

You can call the ask for an IMR in different ways:

• Call Molina Healthcare’s Member Services department at (800) 869-7165, (TTY: 711)
• Write your independent review request and fax it to (877) 814-0342;
• Or write your independent review request and mail it to:

Molina Healthcare
Attn: Member Appeals
PO Box 4004
Bothell, WA 98041-4004

For help, call Molina Member Services (800) 869-7165, Monday through Friday, 7:30 a.m. to 6:30 p.m. local time.

Important Timeframes

You must ask for a State Fair Hearing within 120 days of getting the letter telling you the appeal decision.

You must ask for an IMR within 21 calendar days of receiving your State Fair Hearing Decision if you do not agree with it.

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.