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Members

Questions and Answers

  •  General
    Who can I call for more information or to answer my questions? Call us. Our Member Services representatives are committed to getting you the help you need. 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? Yes. Click here to view a list of community resources available for you.
    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 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 information? Let your County Department of Job and Family Services (CDJFS) caseworker know if there are any updates to your address, phone number, email address, other insurance coverage or if you are pregnant or have a newborn baby. You can also tell us of changes by updating your information online at MyMolina.com or calling Member Services.
    Why do I need a Member ID card?

    It is important that you carry your ID card at all times. Your Member ID card allows you to get your covered services. Show your ID Card each time you get services. This includes:

     

    • Seeing your 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 primary care provider (PCP) is not the PCP listed my Member ID Card? If you are seeing a different PCP from the one named on your Member ID Card, please call Member Services and we will update the information for you.
    What if I have another health insurance plan? If you have other health insurance coverage, it is important to tell Molina Healthcare and your CDJFS caseworker. Every time you visit your provider’s office, hospital or pharmacy, make sure you present all your health insurance ID cards. You will not lose your health coverage for sharing information about your other insurance. Sharing your health insurance information will help your providers and the insurance companies work together to provide your health care. This is called coordination of benefits.
    Do I have to renew my Medicaid eligibility? Yes, Medicaid eligibility is renewed every 12 months. This is also called Medicaid redetermination. In order to keep your Medicaid benefits, you must report your income to your local CDJFS office. Learn more.
    What if my income changed or my family size changed? Do I need to do anything? Please contact your CDJFS caseworker and give him or her this information right away.
  •  Getting Care
    How do I find a provider?

    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 doctor is not in our network, we will help you find other high-quality providers that can meet your needs. View our Provider Directory to see if your health care providers are part of our provider network.

    How do I change my PCP? Visit our Provider Directory to find a network PCP in your area. To change your PCP, log on to MyMolina.com or call Member Services. Molina Healthcare will send you 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 PCP‘s office is closed?

    If your PCP’s office is closed or you 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 benefits and services, including the prescription drugs that we cover.
    Why do some services require prior authorization? Most services are available to you without prior authorization. Some services do require prior authorization. We have this process in place to make sure you are receiving the right care. Your Care Manager and Molina Healthcare’s prior authorization team are ready to help you with the process. Our process helps keep you 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.

  •  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:


     

    • Provider appointments

    • Dental and vision care

    • Prescription medications

    • Durable medical equipment (DME)

    • Treatments needed to receive quality care for your medical conditions

    • 24-Hour Nurse Advice Line

    • Transportation

     


     

    We also help to remove barriers to getting your services and consider your 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, you get 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 you get covered health care services. This includes:


     

    • Doctor visits

    • Dentist visits

    • Hospital visits

    • Women, Infants and Children (WIC) program appointments

    • Appointment to renew your Medicaid coverage at your local County Department of Job & 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 you 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 to see a private provider, you may choose a behavioral health provider within Molina’s network for up to 25 office visits in a 12-month period without a prior authorization. This means that you may visit a provider up to 25 times in the 12 months after the date of your first visit with that provider. These 25 visits do not need prior authorization from Molina Healthcare.

  •  Pharmacy
    Does Molina Healthcare cover prescription drugs?

    Yes. As a member of Molina Healthcare, you have no co-pays or out-of-pocket costs for prescription medications. You should never pay for your prescriptions. Go to the Prescription Drugs page to learn more. Our Pharmacy Department can help you get the prescription medications you need. 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. Your providers use it when prescribing you a drug. If you use a drug on the list, Molina Healthcare will pay for it. This means you can get your 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 drug is not on the Preferred Drug List? If you find out that your drug is not on the list, call Member Services. Ask them to make sure that your 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 medical condition the same way. To get a copy of the list, call Member Services or review the Preferred Drug List here. We will work with you to find a drug that meets your 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 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 you need 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 you. We review each prior authorization request carefully, considering your needs first, and let you and your provider know of our decision. Learn more.
    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.

    Is durable medical equipment (DME) covered? Molina Healthcare works with DME companies. These companies provide all the equipment and supplies for your medical needs. View our Provider Directory to see the DME suppliers in our provider network.
    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 to take your 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 to take your medicine.

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

      • ​How to take your 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 you should not take. Sometimes when two drugs are taken together, it can be dangerous for you or can stop your 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 you are 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 you to take the drugs together during the day. If you take 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 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 you 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 you best. We work with our network pharmacies to keep you safe and healthy.

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