Questions & Answers
Q. How do I get medical services?
A. You should get all health care from Molina Healthcare providers. Your Provider Directory lists all the providers that are part of the plan. If you need a printed copy, call Member Services. It also lists other places you can go.
You can get the care you need from your Primary Care Provider (PCP). Your PCP can help you with the following:
- Tests and results
- Specialist visits
- Hospital visits
You may also see these providers for physical exams and preventive care:
- Federal Qualified Health Centers
- Rural Health Clinics
- County Health Departments
- Each member of your family can have a different PCP or you can pick the same PCP for the entire family.
- You can change your PCP every (30) days. If your request is made before the 25th of the month, the change will be effective the 1st day of the current month. If the change is made after the 25th of the month, the change will be effective on the first day of the next month.
- You will be sent a new Member ID Card. The Member ID Card will have the new PCP’s name, phone number and effective date of the change.
- Go to MyMolina and follow the instructions. If you have not registered for MyMolina yet, you can do it online today. It’s easy!
If your PCP has changed, call your new doctor to fill out a Medical Records Release Form. This will help your new doctor get your medical records from your previous doctor. The Form is in your Membership Welcome Packet. If you need a copy of the form, call Member Services.
Q. How do I get translation services?
A. If you prefer to speak in your own language, Member Services can help. There is no cost to you. Call Member Services. If you are hard of hearing, call our TTY line. An interpreter will be available to speak with you. If you have an appointment, your doctor can help you find an interpreter. They can also help you speak to the doctor. An interpreter can help you:
- Make an appointment.
- Talk with your doctor or nurse.
- Get emergency care.
- File a complaint, grievance or appeal.
- Get help from a pharmacist about taking medicine.
Q. What is an authorization?
A. When an approval is needed, it is called a “prior authorization”. Your PCP will take care of any referrals or authorizations you need.
Q. Who can I call with questions, concerns or complaints?
A. Our Member Services team can help you. Our staff is bilingual and can answer any questions that you may have about your health plan benefits.
Q. How does Molina Healthcare look at new services?
A. Molina uses a medical review process to rate:
- A new drug
- Medical device
- Medical rule or procedure
- Surgical rule or procedure
- Behavioral health rule or procedure
We want to make sure that it is safe for sure. We also want to know if it is good for a medical symptom or condition. It is compared to cures. The goals of this process are:
- To review and update coverage choices as new scientific proofs are found.
- To review cases in order to decide if it is a certain service we should cover or not.
Molina Healthcare may deny a drug, device, protocol, procedure or other therapy that is new. We might say it is not medically necessary. If this happens, you can ask us why. You or your doctor can ask for this information. You can have copies of all the rules and procedures we used to make the decision. For information on this process, call Member Services.
Q. How do I get behavioral health services?
A. We can help you get behavioral health services. We can find you help for drug and alcohol abuse. Call Beacon Health Options at 1-855-371-3945
Q. When do I get my new Member Handbook and Member ID Card?
A. You should receive your Member Handbook and Molina Healthcare Member ID Card the first week after your enrollment is effective with Molina Healthcare.
Q. What if I need vision care?
A. As a member of Molina Healthcare, your vision care is provided to you by iCare.
If you need vision care, you must go to a doctor that is part of the iCare Health Solutions. To find a vision care center close to you, please call the Molina's Member Services Department.
Q. How can I get specialty care?
A. Your PCP will take care of most of your needs. There will be times when you will need to see other type of doctors. These doctors are called specialists. Examples of specialists are:
- ENTs (Ear, Nose & Throat)
There are some providers that do need referrals. For example:
It is a good idea to check with Member Services if the doctor is part of Molina Healthcare. If you need a provider that is not part of Molina Healthcare, call your PCP to get prior approval from Molina.
Q. What if my doctor sends me for lab tests?
A. Your doctor will be sending your lab tests to Quest Diagnostics. If you need to take a lab test outside of your physician’s office, please go to Quest Diagnostics. To find a location near you, please call (866) MyQuest (866-697-8378) or you can go to www.QuestDiagnostics.com.
Q. How do I make an appointment?
A. You should see your PCP within 90 days of your enrollment or sooner. You should be able to get an appointment with your PCP or a specialist as follows:
- Urgent Care – within (1) day
- Routine Sick Care – within (1) week
- Well Care – within (1) month
Please contact us if you cannot get an appointment when you need one. You may call Member Services for help.
Q. How do I join Molina Healthcare?
A. If you qualify for Medicaid and want to become a member call Choice Counseling at (877) 711-3662.
Q. What drugs are covered? Are my drugs covered?
A. To find out what drugs are covered under your plan, view the Preferred Drug List (Formulary) for your plan in “What’s Covered”.
Q. What kind of transportation do I get? I need help with transportation.
A. Go to “What’s Covered” and you will find information about transportation under “Services”. You can also call Member Services at (866) 472-4585
Q. How do I find out if a health care service or benefit is covered?
A. Go to “What’s Covered” to find out about your benefits and services. You can also call Member Services at (866) 472-4585