Complaints, Grievances, & Appeals
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. A complaint is the first part of the grievance process. Complaints are solved by the end of the next day. If they are not solved, they are moved to a grievance within 24 hours.
Types of complaints and grievances may include:
- You have a problem with the quality of your care.
- Wait times are too long.
- Your doctors or the doctor’s staff behaves badly.
- You can’t reach someone by phone.
- You can’t get information.
- A doctor’s office is not clean.
- Your enrollment ends and you didn’t want it to.
- You can’t find a provider in your area.
- You can’t get your drug.
An appeal can be filed when you do not agree with Molina Healthcare’s decision to:
- Stop, suspend, reduce or deny a service.
- Deny payment for services provided.
We want you to have access to the complaint, grievance or appeal process. The Grievance and Appeals Department and Member Services can help you with this process. They are free by calling (866) 472-4585, Monday to Friday, from 8 a.m. - 7 p.m. or for TTY/TDD at (800) 955-8771.
If you wish to talk in your own language, we can help. A translator is available to talk with you and help you file the request. This service is free to all members. We can help you through each step.
- How to file a complaint or grievance
- How to appeal a denial
- How to file an expedited appeal
- Continuing Benefits during appeal process
- Request a Medicaid Fair Hearing
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