Molinalogo

We want to give you good care

Molina Healthcare works with our providers to give you good health care. We look at your member benefits and make choices about care based on what you need. We want you to know:

• We do not reward providers to deny care.
• We do not reward staff or other people to deny care or give you less care.
• We do not pay extra money to providers or our staff members to deny tests or treatments that you need to get better or stay healthy.

If you have a concern about your health care, call Member Services at (877) 814-2221 / TTY/TDD (800) 479-3310.

• Our staff is here to take calls Monday through Friday (except holidays) between 7 a.m.-7 p.m. If you call after 7 p.m. or over the weekend, you will be directed to the Nurse Advice Line and staff there can help you.
• There are nurses you can talk to about health care choices and getting care through our Nurse Advice Line.
• A bilingual staff member or interpreter is available for members.

Primary Care

See your primary care provider (PCP) for a health checkup. Many people wait until they are very sick to see a provider. You do not need to wait. Make sure you schedule a checkup before you get sick. This will help keep you well.

Specialty Care

A primary care provider (PCP) can handle most health care needs. There are special problems such as a broken bone or heart disease where you may need to see another type of provider who has extra training. This provider is called a specialist. If members need to see a specialist, their PCP will make sure they see the right one and may be able to help them get an appointment faster.

Out-of-Area Care

If you are away from Molina Healthcare’s service areas and need emergency care, go to the nearest emergency room for care. If you go to an Emergency Room, make sure the staff at the Emergency Room calls to notify Molina Healthcare of your treatment within 24 hours of the service. Please contact Molina Healthcare within 24 hours or when medically reasonable of getting urgent or emergency care. Call toll-free (877) 814-2221. If you are deaf or hard of hearing, call our dedicated TTY line toll-free (800) 479-3310. Emergency services are covered inside and outside of Sacramento County.

Out-of-Network Services

If a Molina Healthcare provider is unable to give a member necessary and covered services, Molina Healthcare must cover the services through an out-of-network provider. The cost to members should be no more than it would be if the provider were in Molina Healthcare’s network. This must be done quickly for as long as Molina Healthcare is unable to provide the service.

After-Hours Care

Urgent care is when you have a health problem, condition, illness or injury that needs medical care right away but is not life threatening. For urgent care, call your medical home, tell them what happened, and follow their instructions.

After hours, you may call the Nurse Advice Line at (888) 275-8750 to assist you in getting urgent care. For the hearing impaired, please call TTY (866) 735-2929.

Emergency Care

An emergency is a medical or psychiatric condition, including severe pain, manifesting itself by acute symptoms of a sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

• Placing the individual’s health in serious jeopardy, or
• Causing serious impairment to bodily functions, or
• Causing serious dysfunction of any bodily organs or parts.

Examples include:

• Broken bones
• Chest pain
• Severe burns
• Fainting
• Drug overdose
• Paralysis
• Severe cuts that won’t stop bleeding

Emergency services are covered inside and outside of Sacramento County. If you have a medical emergency, go to the nearest emergency room or call 911, even if out of network. You are covered for emergency services both in and out of Sacramento County with no prior authorization needed. If you are seen in the emergency room, you should follow up with your PCP afterwards and let him or her know what happened and what treatment you received.

If you get emergency care from a provider (a hospital or an emergency physicians group) that is not contracted with Molina Healthcare and you get a bill from the provider, please call Member Services at (877) 814-2221. They will contact the provider on your behalf.

Second Opinions

Members who do not agree with a provider’s plan of care have the right to a second opinion from another Molina Healthcare provider or from an out-of-network provider. This service is at no cost to the member.

Language Assistance

Members have a right to an interpreter. There is no cost. Members should tell the office staff if they would prefer to talk in their own language. They can call Member Services for help at (877) 814-2221 / TTY/TDD (800) 479-3310.