We give you good care!
Molina Healthcare works with our network providers to give you good health care. We look at your member benefits and make choices about care based on what you need. We promote and share information about evidence-based health care and encourage providers to provide excellent care and service. 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
Members who have a concern about their health care can call Member Services.
- Our staff is here to take calls Monday to Friday (except holidays), 7 a.m. - 7 p.m. If members call after 7 p.m. or over the weekend, they can leave a message and their phone number. Our staff will return the call in a timely manner, no more than one business day.
- Staff is also available to accept collect calls.
- Members can talk to nurses about health care choices and getting the needed care available through our Nurse Advice Line.
- A bilingual staff member or interpreter is available for members.
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 and your children well.
A primary care provider (PCP) can handle most health care needs. But sometimes there are special problems such as a broken bone or heart disease. A visit to a provider who has extra training may be needed. 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. Please contact Molina Healthcare within 24 hours or when medically reasonable of getting urgent or emergency care. Call toll-free (800) 642-4168. If you are deaf or hard of hearing, call Ohio Relay/TTY at (800) 750-0750 or 7-1-1. When you are away from Molina Healthcare’s service area, only urgent or emergency care is covered. No services are covered outside the United States, except for emergency services requiring hospitalization in Canada or Mexico.
Out of Network Services
If a Molina Healthcare provider is unable to provide a member with necessary and covered services, Molina Healthcare must cover the needed services through an out-of-network provider. The cost to members should be no greater than it would be if the provider were in Molina Healthcare’s network. This must be done in a timely manner for as long as Molina Healthcare is unable to provide the service.
After Hours Care
Urgent care services are available when you are within or outside of Molina Healthcare’s service area. However, no services are covered outside the United States, except for emergency services requiring hospitalization in Canada or Mexico. Urgent care services are those services needed to prevent the worsening of one’s health from an unforeseen medical condition or injury. You have the right to interpreter services at no cost to you to help in getting after hours care. Call Member Services at (800) 642-4168.
Sometimes you or your child gets ill after hours. If you can, wait until the next day when the doctor’s office is open or you can also call our Nurse Advice Line toll-free (888) 275-8750 or for hearing impaired TTY/Ohio Relay (866) 735-2929. Our nurses can help you any time of the day or night. They will tell you what to do or where to go to be seen. You can also ask your PCP the name of the urgent care center that you are to use in these cases. It is best to find out ahead of time. Ask your doctor the name of the urgent care center and the name of the hospital that you are to use.
Emergency care is available twenty-four (24) hours a day, seven (7) days a week for Molina Healthcare members.
Emergency health care services are health services needed to evaluate or stabilize an emergency medical condition, which is a medical or psychiatric medical condition having acute and severe symptoms (including severe pain). If immediate medical attention is not received, it could result in any of the following:
- Placing the patient’s health in serious danger.
- Serious damage to bodily functions.
- Serious dysfunction of any bodily organ or part.
Emergency health care also includes emergency contraceptive drug therapy.
Emergency health care includes urgent care services that cannot be delayed in order to prevent serious deterioration of health from an unforeseen condition or injury.
If you think you have an emergency:
- Call 911 right away.
- Go to the closest hospital or emergency department (ED).
When you go for emergency care, carry your Molina Healthcare Member ID Card.
If you are not sure if you need emergency care, call your PCP or call our 24-Hour Nurse Advice Line toll-free (888) 275-8750, or for hearing impaired TTY/Ohio Relay (866) 735-2929. The Nurse Advice Line is staffed by registered nurses (RNs). You can call the Nurse Advice Line 24 hours a day, 7 days a week.
Hospital emergency rooms are only for real emergencies. These are not good places to get non-emergency care. They are often very busy and must care first for those whose lives are in danger. Please do not go to a hospital emergency room if your condition is not an emergency.
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.
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 (800) 642-4168 or for hearing impaired TTY/Ohio Relay (800) 750-0750 or 7-1-1.