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Members

Complaints and Appeals

Molina Healthcare logo

As a Molina Healthcare member, if you have a problem with your medical care or our services, you have a right to file a complaint (grievance) or appeal. Some examples are:  

  • The care you get from your provider.
  • The time it takes to get an appointment or be seen by a provider.
  • The providers you can choose for care.
     
An appeal can be filed when you do not agree with Molina Healthcare’s decision to: 
 
  • Stop, change, suspend, reduce or deny a service.
  • Deny payment for services provided.
     

What if I Have a Complaint?
If you have a problem with any Molina Healthcare services, we want to help fix it. You can call any of the following toll-free for help:

Call Molina Healthcare toll-free at (888) 858-2150, Monday to Friday, 8:00 a.m. - 6:00 p.m TTY users can dial 711.

You may also send us your problem or complaint in writing by mail​ or by registering to My Molina at https://member.molinahealthcare.com/Member/Login. Our address is:
Molina Healthcare
Grievance and Appeals Unit
200 Oceangate, Suite 100
Long Beach, California 90802

Call the California State Department of Managed Health Care (DHMC) toll-free at (888) HMO-2219 (888) 466-2219).

Molina Healthcare recognizes the fact that Members may not always be satisfied with the care and services provided by our contracted doctors , hospitals and other providers. We want to know about Your problems and complaints. You may file a grievance (also called a complaint) in person, in writing, or by telephone as described above.
 
We will send You a letter acknowledging receipt of Your grievance within five (5) calendar days and will then issue a formal response within thirty (30) calendar days of the date of Your initial contact with us. All levels of grievances will be resolved within thirty (30) calendar days.
 
A Member Appeal may be requested by the member or his/her designee orally in person, via telephone, fax, E-mail, or mail within one-hundred eighty (180) calendar days after the member’s receipt of the A Member Appeal may be requested by the member or his/her designee orally in person, via telephone, fax, E-mail, or mail within one-hundred eighty (180) calendar days after the member’s receipt of the Notice of Action (NOA).

We will send You a letter acknowledging receipt of Your appeal within five (5) calendar days. All levels of Molina Healthcare’s grievances and appeal procedures will be completed within thirty (30) calendar days.
 
You must file Your grievance within one hundred eighty (180) calendar days from the day the incident or action occurred which caused You to be unhappy.
 
Expedited Review
If your grievance involves an imminent and serious threat to your health, Molina Healthcare will quickly review Your grievance. Examples of imminent and serious threats include, but are not limited to, severe pain, potential loss of life, limb, or major bodily function. You will be immediately informed of your right to contact the Department of Managed Health Care. Molina Healthcare will issue a formal response no later than three (3) calendar days after your initial contact with us. You may also contact the Department of Managed Health Care immediately and are not required to participate in Molina Healthcare’s grievance process.
 
Department of Managed Health Care Assistance
The California Department of Managed Health Care is responsible for regulating health care services plans. If You have a grievance against Your health plan, You should first telephone Your health plan toll-free at (888) 858-2150, and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to You. If You need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by Your health plan, or a grievance that has remained unresolved for more than thirty (30) days, You may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If You are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll free telephone number (888) 466-2219 and a toll-free TTD line ((877) 688-9891) for the hearing and speech impaired. The department’s Internet website http://www.hmohelp.ca.gov has complaint forms, IMR applications forms and instructions online.
 
Independent Medical Review
You may request an independent medical review (“IMR”) of a Disputed Healthcare Service from the Department of Managed Health Care (“DMHC”) if You believe that healthcare services have been improperly denied, modified, or delayed by Molina Healthcare or one of its Participating Providers. A “Disputed Healthcare Service” is any healthcare service eligible for coverage and payment (also called Covered Services) that has been denied, modified, or delayed by Molina Healthcare or one of its Participating Providers, in whole or in part because the service is not Medically Necessary.
The IMR process is in addition to any other procedures or remedies that may be available to You. You pay no application or processing fees of any kind for IMR. You have the right to give information in support of the request for an IMR. Molina Healthcare will give You an IMR application form with any disposition letter that denies, modifies, or delays healthcare services. A decision not to take part in the IMR process may cause You to lose any statutory right to take legal action against Molina Healthcare regarding the disputed health care service.
 
Eligibility for IMR: Your application for an IMR will be reviewed by the DMHC to co
1.   Either:
A.  Your provider has recommended a healthcare service as Medically Necessary, or
B.  You have received Urgent Care or Emergency Services that a provider determined was Medically Necessary, or
C.  You have been seen by a Participating Provider for the diagnosis or treatment of the medical condition for which You seek medical review;
2.   The Disputed Healthcare Service has been denied, modified, or delayed by Molina Healthcare or one of its Participating Providers, based in whole or in part on a decision that the healthcare service is not Medically Necessary: and
3.   You have filed a grievance with Molina Healthcare or its Participating Provider and the disputed decision is upheld or the grievance remains unresolved after thirty (30) calendar days. You are not required to wait for a response from Molina Healthcare for more than thirty (30) calendar days.
 
If Your grievance requires Expedited Review You may bring it immediately to the DMHC’s attention. You are not required to wait for response from Molina Healthcare for more than three (3) calendar days. The DMHC may waive the requirement that You follow Molina Healthcare’s grievance process in extraordinary and compelling cases.
 
If Your case is eligible for IMR, the dispute will be submitted to a medical specialist who will make an in​de​pendent determination of whether or not the care is Medically Necessary. You will get a copy of the assessment made in Your case. If the IMR determines the service is Medically Necessary, Molina Healthcare will provide the healthcare service.

For non-urgent cases, the IMR organization designated by the DMHC must provide its determination within thirty (30) calendar days of receipt of Your application and supporting documents. For urgent cases involving an imminent and serious threat to Your health, including but not limited to, serious pain, the potential loss of life, limb, or major bodily function, or the immediate and serious deterioration of Your health, the IMR organization must provide its determination within three (3) calendar days.
 
For more information regarding the IMR process, or to request an application form, please call Molina Healthcare toll-free at (888) 858-2150. If You are deaf or hard of hearing, call our dedicated TTY line toll-free at (800) 735-2989, or call the California Relay Service at 711.
 
Independent Medical Review for Denials of Experimental/Investigational Therapies
You may also be entitled to an Independent Medical Review of our decision to deny coverage for treatment we have determined to be Experimental or Investigational.
 
The treatment must be for a life-threatening or seriously debilitating condition.
 
We will notify You in writing of the opportunity to request an Independent Medical Review of a decision denying an Experimental/ Investigational therapy within five (5) business days of the decision to deny coverage.
 
You are not required to participate in Molina Healthcare’s grievance process prior to seeking an Independent Medical Review of our decision to deny coverage of an Experimental/ Investigational therapy. 

The Independent Medical  Review will be completed within thirty (30) calendar days of the Department of Managed  Health Care's receipt  of Your application and supporting documentation. If Your doctor determines that the proposed  therapy would be significantly less effective  if not promptly initiated,  the Independent Medical Review  decision  shall be rendered  within  seven (7) calendar days of the completed request  for an expedited review.
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​Language Information

If you, or someone you’re helping, has questions about Molina Marketplace, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1 (888) 858-2150.

Información de idioma

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Molina Marketplace, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete,llame al 1 (888) 858-2150 .

语言信息

如果您,或是您正在協助的對象,有關於[插入 Molina Marketplace 項目的名稱 Molina Marketplace 方面的問題,您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員,請撥電 話 [在此插入數字 1 (888) 858-2150 。

Thông Tin Ngôn Ngữ

Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Molina Marketplace, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1 (888) 858-2150.

Impormasyon sa Wika

Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Molina Marketplace , may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa 1 (888) 858-2150 .

언어 정보

만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 Molina Marketplace 에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다.그렇게 통역사와 얘기하기 위해서는 1 (888) 858-2150 로 전화하십시오.

Լեզվի մասին տեղեկություն

Եթե Դուք կամ Ձեր կողմից օգնություն ստացող անձը հարցեր ունի Molina Marketplace մասին, Դուք իրավունք ունեք անվճար օգնություն և տեղեկություններ ստանալու Ձեր նախընտրած լեզվով։ Թարգմանչի հետ խոսելու համար զանգահարե՛ք 1 (888) 858-2150 ։

ات ترجمه و زبان

اگر شما، یا کسی که شما به او کمک میکنید ، سوال در مورد [Molina Marketplace] ، داشته باشید حق این را دارید که کمک و اطلاعات به زبان خود را به طور رایگان دریافت نمایید 1-888-858-2150. تماس حاصل نمایید.

​Информация о языках

Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Molina Marketplace, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1 (888) 858-2150 .

言語情報

ご本人様、またはお客様の身の回りの方でも、 Molina Marketplace についてご質問がござい ましたら、ご希望の言語でサポートを受けたり、情報を入手したりすることができます。料 金はかかりません。通訳とお話される場合、1 (888) 858-2150 までお電話ください。

معلومات اللغة

إن كان لديك أو لدى شخص تساعده أسئلة بخصوص Molina Marketplace ، فلديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلفة. للتحدث مع مترجم اتصل بـ 2150-858 (888)1 .

ਭਾਸ਼ਾ ਦੀ ਜਾਣਕਾਰੀ

ਜੇ ਤੁਹਾਨੰ ੂ , ਜ䀁ߠਤੁਸੀ ਿਜਸ ਦੀ ਮਦਦ ਕਰ ਰਹੇ ਹੋ , Molina Marketplace ਕੋਈ ਸਵਾਲ ਹੈ ਤ䀁߬ ਤੁਹਾਨੰ ੂ ਿਬਨਾ ਿਕਸ ੇ ਕੀਮਤ 'ਤੇ ਆਪਣੀ ਭਾਸ਼ ਿਵੱਚ ਮਦਦ ਅਤੇ ਜਾਣਕਾਰੀ ਪ䀂ǠȾਪਤ ਕਰਨ ਦਾ ਅਿਧਕਾਰ ਹੈ . ਦੁਭਾਸ਼ੀ ਨਾਲ ਗੱਲ ਕਰਨ ਲਈ, 1-888-858-2150 ਤੇ ਕਾਲ ਕਰੋ .

សេវាកម្មភាសា

ប្រសិនបរើអ្នក ឬនរណាម្នក់ដែលអ្នកកំពុងដែជយ ម្ននសំណរអ្ំពី Molina Marketplace បេ, អ្នកម្ននសិេេេួលជំនយនិងព័ែ៌ម្នន បៅកនុងភាសា ររស់អ្នក បោយមិនអ្ស់ប្ាក់ ។ បែើមបីនិយាយជាមយអ្នករកដប្រ សូម 1-888-858-2150 ។

Lus Qhia txog Hom Lus

Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Molina Marketplace , koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 1 (888) 858-2150 .

​भाषा की जानकारी

यदि आपके, या आप द्वारा सहायता किए जा रहे किसी व्यक्ति के Molina Marketplace के बारे में प्रश्न हैं, तो आपके पास अपनी भाषा में मुफ्त में सहायता और सूचना प्राप्त करने का अधिकार है। किसी दुभाषिए से बात करने के लिए, 1 (888) 858-2150 पर कॉल करें।

​ข้อมูลภาษา

หากคณ หรอคนทคณกาลงชวยเหลอมคาถามเกยวกบ Molina Marketplace คุณมสทธทจะไดรบความชวยเหลอและขอมลในภาษาของคณไดโดยไมมคุาใชจาย พุดคยกบลาม โทร 1 (888) 858-2150

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