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Members

Questions & Answers

  •  General
    Who can I call for more information or to answer my questions? Call us. Our Member Services representatives are committed to getting your child the help he or she needs. If the office is closed, you can leave a message. A Member Services representative will get back with you.
    What if I get a bill?

    Molina Healthcare members do not have to pay co-payments or other charges for medical services. If you receive a statement from a provider:

     

    • Check to see if the statement shows if you are being asked to pay charges. If it does, call Member Services. We will help you.

    • If the statement does not show you need to pay charges, it means you received a statement, not a bill. The provider is letting you know that your insurance company has been billed for the services provided. It might say “this is not a bill” on the page.

    • If you did not receive the services listed in the statement, please call Member Services.

    • A provider may ask you to sign a waiver stating that you are agreeing to be responsible for non-covered services.

     

    Does Molina Healthcare provide information on other community resources or other supportive services available to my child? Yes. Click here to view a list of community resources available for you and your child or contact your Care Manager for assistance
    How do I get interpreter services? Call Member Services and let us know you need an interpreter. We will arrange it for you. You also have the right to interpreter services at your child’s provider's office. Tell the office staff if you would prefer to talk in your own language.
  •  Personal Information and Medicaid Eligibility
    How do I update my child’s information? Let your County Department of Job and Family Services caseworker know if there are any updates to your address, phone number, email address, other insurance coverage or if your child is pregnant or has a newborn baby. You can also tell us of changes by updating your child’s information online at MyMolina.com or calling Member Services.
    Why does my child need a Member ID card?

    It is important that you carry your child’s ID card at all times. Your child’s Member ID card allows your child to get his or her covered services. Show your child’s ID Card each time your child gets services. This includes:

     

    • Seeing his or her primary care provider (PCP) or other providers

    • Visiting the emergency room

    • Going to an urgent care facility

    • Going to a hospital

    • Getting medical supplies

    • Getting a prescription

    • Getting medical tests

     

    What if my child’s primary care provider (PCP) is not the PCP listed his or her Member ID Card? If your child is seeing a different PCP from the one named on his or her Member ID Card, please call Member Services and we will update the information for you.
    What if I have another health insurance plan? If your child has other health insurance coverage, it is important to tell Molina Healthcare and your County Department of Job and Family Services caseworker. Every time you visit your child’s provider’s office, hospital or pharmacy, make sure you present all his or her health insurance ID cards. Your child will not lose his or her health coverage for sharing information about other insurance. Sharing health insurance information will help your child’s providers and the insurance companies work together to provide your child’s health care. This is called coordination of benefits.
    Do I have to renew my child’s Medicaid eligibility? Yes, Medicaid eligibility is renewed every 12 months. This is also called Medicaid redetermination. In order to keep your child’s Medicaid benefits, you must report your income to your local County Department of Job and Family Services office. Learn more.
    What if my income changed or my family size changed? Do I need to do anything? Please contact your County Department of Job and Family Services caseworker and give him or her this information right away.
  •  Getting Care
    How do I find a provider for my child? Molina Healthcare contracts with primary care providers (PCPs), specialists and pediatricians all over Ohio. These are called our network providers. We want you to have as few changes as possible when you join Molina Healthcare. If your child’s doctor is not in our network, we will help you find other high-quality providers that can meet your child’s needs. View our Provider Directory to see if your child’s pediatrician and other health care providers are part of our provider network.
    How do I change my child’s PCP? Visit our Provider Directory to find a network PCP in your area. To change your child’s PCP, log on to MyMolina.com or call Member Services. Molina Healthcare will send your child a new Member ID Card with the provider’s name. The card also includes the date the change went into effect. Learn more about the Member ID Card.
    Does Molina Healthcare require a referral to see a specialist? No. However, some specialists do require a referral from a PCP before they will see your child. A referral is when your provider or PCP recommends that you visit another provider for a specific service.
    Can I contact Molina Healthcare after normal business hours with a medical concern? Yes. For medical related non-emergency questions, contact our 24-Hour Nurse Advice Line at (888) 275-8750.
    What if I need care after my child’s PCP‘s office is closed?

    If your child’s PCP’s office is closed or your child cannot be seen right away, you may go to an urgent care center or CVS Minute Clinic. Visit our Provider Directory to find an urgent care center in your area.

    If you are not sure where to go for care, call our 24-hour Nurse Advice Line for help at (888) 275-8750.

    If you have an emergency, call 911 or go to the nearest emergency room. Emergency care is provided when a medical problem is so serious that it must be treated right away. Members can go to any emergency room without a referral or prior authorization for emergency treatment.

    Are there co-pays or out-of-pocket costs for services and prescription medications? Molina Healthcare covers all medically necessary Medicaid covered services, prescription medications and durable medical equipment (DME) at no cost to you. We also cover transportation. That means $0 co-pays and no out-of-pocket costs. View “What’s Covered” to learn more about your child’s benefits and services, including the prescription drugs that we cover.
    Why do some services require prior authorization? Most services are available to your child without prior authorization. Some services do require prior authorization. We have this process in place to make sure your child is receiving the right care. Your child’s Care Manager and Molina Healthcare’s prior authorization team are ready to help you with the process. Our process helps keep your child safe and healthy. To find out if a benefit or service requires prior authorization, click here to view “What’s Covered.”
    What happens if a requested service is denied?

    If a service is denied coverage by Molina Healthcare, you can make an appeal within 90 days in one of four ways:

     

    • Call Member Services
    • Fax (888) 295-4761
    • Tell your Care Manager
    • Send us a letter at P.O. Box 349020, Columbus, OH 43234-9020

     


    Click here to learn more.

  •  Care Management
    What is Care Management?

    Molina Healthcare’s care management program provides a family-centered way of connecting your child to the quality care services he or she needs. We work together with you and your child, our medical directors and your child’s providers for a smooth coordination of all the services your child needs.

    Our Care Management team includes nurses, social workers, pharmacy technicians and dieticians. Your child’s Care Manager will stay in contact with you and help your child with his or her health and well-being. Learn more.

    What is the role of a Care Manager?

    A Care Manager is your Molina Healthcare point-of-contact. He or she will help you in coordinating care for your child. Your Care Manager will:

     

    • Coordinate easier access to needed quality care

    • Help you find a provider

    • Arrange transportation​ to appointments

    • Help you navigate the health care system

    • Help you understand your child's medication

    • Develop, with you, a personal care plan for your child

    • Work with your doctor to give you the best care

     

    Learn more about care management.

  •  Benefits & Services
    What benefits and services does Molina Healthcare cover?

    As a managed care plan, we cover all medically necessary health care benefits and services that are covered by Ohio Medicaid Fee-for-Service (FFS). This includes your child’s:

     

    • Provider appointments

    • Dental and vision care

    • Prescription medications

    • Durable medical equipment (DME)

    • Treatments needed to receive quality care for his or her medical conditions

    • 24-Hour Nurse Advice Line

    • Transportation

     

    We also help to remove barriers to getting your child’s services and consider your child’s needs as we work toward healthier outcomes. View “What’s Covered” to learn more about benefits and services.

    How many dental cleanings does Molina Healthcare cover per year? We cover one cleaning/checkup once every 6 months.
    Does Molina Healthcare cover vision benefits?

    Yes. We cover:

    • Eye Exams
      • One every 12 months
    • Eyeglasses - One complete frame and pair of lenses, just lenses or just frames. Contact lenses require prior approval. We also offer an expanded selection of frames to choose from at no cost to you.
      • One every 12 months
    Does Molina Healthcare cover transportation?

    Yes, your child gets an extra transportation benefit with Molina Healthcare. You get 30 one-way trips (15 round-trips) every calendar year at no cost to you. This benefit will get you to and from places where your child gets covered health care services. This includes:

     

    • Doctor visits

    • Dentist visits

    • Hospital visits

    • Women, Infants and Children (WFC) program appointments

    • Appointment to renew your Medicaid coverage at your local County Department of Job and Family Services (CDJFS) office

    • Stops at the pharmacy after a medical visit. This will not be counted as a separate trip.

     

    In addition to your 30 trips, our plan covers unlimited rides for members who get these services:

     

    • Dialysis

    • Chemotherapy

    • Radiation therapy

    • Wheelchair vans

     

    Additionally, transportation is always available if your child must travel 30 miles or more from your home to get covered health care services. These rides are unlimited for services that are medically needed, but only if there is not a provider closer to your home. Click here to learn more.

    Does Molina Healthcare cover home health services? Yes. All home health services must be ordered by a provider. Also, an assessment by a registered nurse must be done before the service begins or any changes are made to the service package. A prior authorization may also be needed.
    Does Molina Healthcare cover behavioral health services? Members may self-refer to community mental health centers for any services they may need. If you prefer for your child to see a private provider, you may choose a behavioral health provider within Molina Healthcare’s network for up to 25 office visits in a 12-month period without a prior authorization. This means that your child may visit a provider up to 25 times in the 12 months after the date of his or her first visit with that provider. These 25 visits do not need prior authorization from Molina.
  •  Pharmacy
    Does Molina Healthcare cover prescription drugs?

    Yes. As a member of Molina Healthcare, your child has no co-pays or out-of-pocket costs for prescription medications. You should never pay for your child’s prescriptions. Go to the Prescription Drugs page to learn more. Our Pharmacy Department can help you get the prescription medications your child needs. For some medications, you will need to get prior authorization. Learn more.

    To find out what drugs are covered under your plan, view the Molina Healthcare Preferred Drug List (Formulary) for your plan in “What’s Covered”.

    What is the Preferred Drug List? Molina Healthcare’s preferred drug list is a specific list of drugs Molina Healthcare has approved. Providers use it when prescribing​ a drug. If your child uses a drug on the list, Molina Healthcare will pay for it. This means your child can get his or her medicine at no cost to you.
    What drugs are on the Preferred Drug List? There are many drugs on the Preferred Drug List. The list includes both brand-name and generic drugs. Click here to view the Preferred Drug List. To get a printed copy, call Member Services.
    What if my child’s drug is not on the Preferred Drug List? If you find out that your child’s drug is not on the list, call Member Services. Ask them to make sure that your child’s drug is not on the Preferred Drug List. If they say it is not on the list ask your doctor if you can switch to another drug that we do cover. Give your doctor a list of the drugs we pay for. He or she may find another drug on the list that treats your child’s medical condition the same way. To get a copy of the list, contact Member Services review the Preferred Drug List here. We will work with you to find a drug that meets your child’s needs. If a drug is not on our list, your doctor must send us a prior authorization request. We will review your doctor’s reason for the drug that is not on our list. If we approve it, we will pay for your child’s drug.
    What is Molina Healthcare’s policy on brand name drugs? Generic drugs have the same ingredients as brand name drugs. At Molina Healthcare, we call generic drugs our preferred drugs. We require the use of a preferred drug from our preferred drug list (PDL) if one is available. Our Pharmacy Department will work with your provider if he or she says your child needs the brand name instead of the preferred drug. Your provider will submit a prior authorization request to our Pharmacy Department explaining why the preferred medicine will not work for your child. We review each prior authorization request carefully, considering the needs of your child first, and let you and your provider know of our decision. Learn more.
    Is my child’s durable medical equipment (DME) covered? Molina Healthcare works with DME companies. These companies provide all the equipment and supplies for your child’s medical needs. View our Provider Directory to see the DME suppliers in our provider network.
    How does Molina Healthcare decide which drugs to put on the Preferred Drug List?

    The drugs on this list are chosen by a committee made up of doctors and pharmacists. They are from Molina Healthcare and from the medical community. The committee reviews the list every three months and decides which drugs should be on the list. The drugs chosen are the ones that will serve you best.

    The committee also reviews FDA (Food and Drug Administration) reports. These reports talk about new drugs the FDA says are okay for use. They also talk about how well current drugs work. The reports help them know if they should add drugs to the list or take some off.

    What type of service should you expect from a network pharmacy?

    There are certain services you should get from our network pharmacies. They help you know how your child can take his or her medicine the safe and healthy way. When you go to a network pharmacy:

     

    • You should expect to be asked if you want to speak with a pharmacist. This is called a patient consult.

    • During a consult you can ask the pharmacist:

      • How your child can take their medicine.

      • When your child should take it. For example, you might need to take it with or without food.

      • How your child can take his or her drug the safe way.

    • During the consult, the pharmacist may tell you:

      • What the drug is for and how it works.

      • Side effects the drug may cause.

      • How to store the drug. Some drugs must be kept at a certain temperature or in a certain light so they won’t be ruined.

      • About any other drugs your child should not take. Sometimes when two drugs are taken together, it can be dangerous for your child or can stop his or her medicine from working. Ask your pharmacist about any drug interactions.

      • You can also ask for a medication profile review. This is when a pharmacist checks the computer for all of the drugs your child is taking. You will be told the best way to take each one throughout the day. The pharmacist will also make sure it is safe for your child to take the drugs together during the day. If your child takes any vitamins or herbal remedies, now is the time to tell your pharmacist. He or she will let you know if it is okay to take them with your child’s other drugs.

    • Ask if your language (of choice) can be put on the Rx bottle. Also ask if the directions for how to take the drug can be written in your language.

    • During flu season, some of the network pharmacies may offer flu shots for your child as a Molina Healthcare member free of charge. Ask if your pharmacy offers flu shots for Molina Healthcare members.

     

    You should expect these services from your pharmacy. Be sure to use the benefits your pharmacy offers. We only choose network pharmacies that serve your child best. We work with our network pharmacies to keep your child safe and healthy.

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