If you have any questions, please contact Member Services

Grievance and Appeal Form - Use this form to request a redetermination (appeal) or a grievance. Complete this form and mail or fax to:

Molina Healthcare of Ohio, Inc.
Grievance and Appeals Unit
P.O. Box 182273
Chattanooga, TN 37422

Fax: (866) 713-1891 

If you have someone submit the form for you, you must give your consent in the form.

How to File a Grievance
How to Appeal a Denial of Service

Pharmacy Direct Member Reimbursement Form
- If you have paid out of pocket for a pharmacy product, you may be eligible for a reimbursement. Please contact the Member Services Department for further details.

Materials are also available in printed and alternative formats, such as large print, audio, or Braille.