As a Molina Healthcare of South Carolina member, you have the right to file an appeal or grievance if you are unhappy with your medical care or our services.
An appeal is a request for a review of a decision or adverse benefit determination (a decision not made in your favor). Some examples of an appeal are:
- Asking for review of a denial or reduction of services, or
- Asking for review of a denial for a specific drug or pharmaceutical.
A grievance is an expression of dissatisfaction about any matter other than an adverse benefit determination (a decision not made in your favor). Some examples of a grievance include:
- The quality of care rendered by a Molina provider was not suitable
- A Molina employee or one of the Molina providers was rude, or
- Your rights as a Molina member were not respected.
We want you to have access to the appeals and grievances processes and will help you through each step.