How to File an Expedited Review
A member (or someone on their behalf) may request an expedited appeal of a denied service when taking the time for a standard resolution could seriously put at risk the member’s life, health, or ability to attain, maintain, or regain maximum function.
How do I (or someone on my behalf) request an expedited appeal?
Tell Molina Healthcare you would like your appeal expedited by phone, fax, or mail. Molina Healthcare will review your request and decide if it meets the criteria for an expedited appeal.
How soon will Molina Healthcare decide to expedite my appeal?
Molina Healthcare will decide to expedite or not expedite your appeal within 1 business day of the appeal request. We will make a reasonable effort to tell you by phone whether or not we will expedite your appeal. This is just the decision to expedite the appeal or not.
If my appeal is expedited, how soon will a decision be made?
If we expedite your appeal, Molina Healthcare will make a decision as quickly as needed. We will make a decision no more than 72 hours from the time we received your appeal request.
What happens if my appeal does not meet the criteria for an expedited appeal?
If your appeal does not meet the criteria for an expedited decision, Molina Healthcare will tell you that we will not expedite your appeal within 1 business day from the time we received your request. We will tell you this in writing. We will tell you how to file a complaint about our decision to deny the expedited appeal.
If we decide to not expedite your appeal, then your appeal will be reviewed as a standard appeal request. We will make a decision about your appeal within 15 calendar days from the date we received your appeal request. This is the standard resolution timeframe for appeals.
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