Independent medical reviews in Wisconsin

If you or an authorized representative asked for an appeal and got a resolution letter and you do not agree you have the right to 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.

There is no cost for external appeals.

You may be able to have your services continue while your case is reviewed. To ask for continued services, call Molina Member Services (888) 999-2404, Monday through Friday, 8 a.m. to 5 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 90 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 Wisconsin Department

of Administration for a faster hearing. They 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:

Write to:

Department of Administration Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53707-7875

Or call: (608) 266-7709

Or fax: (608) 264-9885

Or email DHAMail@wisconsin.gov

If you need help asking for a State Hearing in your preferred language, we can help. We offer language services at no cost. Call Molina Member Services (888) 999-2404, Monday through Friday, 8 a.m. to 5 p.m. local time.

Important timeframes

You must ask for a State Fair Hearing within 90 days of getting the letter telling you about 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.