Members

How to File a Complaint or Grievance 

compliant

Complaints and Grievances 

If you are unhappy with your child’s medical care or the service your child is getting from Molina and/or its providers, you can file a complaint. You can file a complaint over the phone or in writing. Complaints must be filed within thirty (30) calendar days from the date of the event causing your dissatisfaction. Complaints are considered less serious or formal. All complaints are resolved within one (1) calendar day from when we get the complaint. We will call you within twenty-four (24) hours if for any reason we cannot resolve the issue during the initial contact. If we cannot resolve your complaint within (1) calendar day of getting it, your complaint will be treated as a formal grievance.

You may file a grievance over the phone or in writing at any time. A grievance is an expression of dissatisfaction, regardless of whether you call it a “Grievance”, received by Molina verbally or in writing about any matter or aspect of Molina or its operation, other than a Molina Adverse Benefit Determination. Examples of complaints and grievances are, but are not limited to:

  • You have a problem with the quality of your child’s care
  • Wait times are too long
  • Your child’s PCP or the PCP’s staff is rude
  • You can’t reach someone by phone
  • You are not able to get information
  • A PCP’s office is not clean
  • Your child’s enrollment with Molina ends and you did not ask for this
  • You cannot find a provider in your area
  • You are having trouble getting your child’s prescription
  • Molina extended the timeframe for resolving a grievance or appeal

 

We will send you a letter letting you know that we got your grievance within five (5) calendar days of getting your Grievance. We may call your child’s provider or get help from other Molina departments to investigate your Grievance. You will get a letter with the outcome of your Grievance as quickly as your health condition requires, but no later than
thirty (30) calendar days from when we got your grievance.

You can ask for up to fourteen (14) extra calendar days to resolve your grievance or Molina can take up to fourteen (14) extra calendar days if we need more information for your grievance. We will call you and send you a letter within two (2) calendar days of extending the timeframe. The letter will include the reason why we need more time and how the delay is in your best interest.

At any time you may request a copy of your file, medical records or any material free of charge.

Filing a Complaint or Grievance 

To file your complaint you can:

 

We can accept your complaint, grievance, or appeal from someone else with your
permission. For Example:

  • A friend
  • A family member
  • A provider part of Molina
  • A provider that is not part of Molina
  • A lawyer  

 

Your request needs:

  • You and your child’s first and last name
  • Your signature
  • Date
  • You child’s Member ID number which can be found on the front of his or her Molina member ID card
  • Your address and telephone number
  • Your PCP’s name and telephone number
  • A description of the issue
  • Any records related to your request

Member Complaint/Grievance Forms

Member Complaint/Grievance Request Form

Mail the letter or fax the form to:

Molina Healthcare of Mississippi
Attention: Member Grievance and Appeals

1020 Highland Colony Parkway, Suite 602

Ridgeland, MS 39157

Fax: 1-844-808-2407