Grievance and Appeals
Some examples are:
- The care received from a provider;
- The time it takes to get an appointment or be seen by a provider or;
- The providers a member can choose for care.
- Stop, suspend, reduce or deny a service or;
- Deny payment for services provided.
What is a coverage decision?
A coverage decision is an initial decision we make about your benefits and coverage or about theamount we will pay for your medical services, items, or drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay.If you or your doctor are not sure if a service, item, or drug is covered by Medicare or Medicaid, either of you can ask for a coverage decision before the doctor gives the service, item, or drug. If you disagree with a coverage decision we have made, you can appeal our decision.
- You can call us at: (855) 665-4623 TTY: TTY/TDD: 711,Monday - Friday, 8 a.m. to 8 p.m., local time.
- You can fax us at: ◦ Inpatient Fax: (877) 708-2116 ◦ Outpatient Fax: (844) 251-1450
- You can write to us at: Molina Dual Options MyCare Ohio Attention: Care Access and Monitoring, P.O. Box 349020, Columbus, OH 43234-9020