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Members

We want to give you good care!

Doctor and patient talking

Molina Healthcare works with your doctors to give you good healthcare. We looks at your benefits and make choices about care based on what you need. 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 at:

  • (866) 449-6849 or CHIP Rural Service Area (RSA) (877) 319-6826
  • TTY English (800) 735-2989 or dial 711
  • Relay Texas Spanish (800) 662-4954
  • Our staff is here to take calls Monday to Friday (except holidays), 8:00 a.m. - 5:00 p.m. If members call after 5:00 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.
  • There are nurses you can talk to about your health care choices. They can help you get care. You can call them through our Nurse Advice Line.
  • A bilingual staff member or interpreter is available for members.

Primary Care
See your main doctor for a health checkup. Many people wait until they are very sick to see a doctor. 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.

Specialty Care
A main doctor can handle most health care needs. But sometimes there are special problems such as a broken bone or heart disease. A visit to a doctor who has extra training may be needed. This doctor is called a specialist. If members need to see a specialist, their main doctor 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 urgent care center or emergency room for care. Please contact Molina Healthcare within 24 hours or when medically reasonable of getting urgent or emergency care. Call toll-free (866) 449-6849 or CHIP Rural Service Area (RSA) (877) 319-6826. If you are deaf or hard of hearing, call Relay Texas TTY toll-free (800) 735-2989 or 711 for English or (800) 662-4954 for Spanish. 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. Only services for emergency services requiring hospitalization in Canada or Mexico.

Out of Network Services
If a Molina Healthcare provider cannot give services, Molina Healthcare must cover the needed services. They do this through an out-of-network provider. The cost to members should not be more than it would be if the doctor were in Molina Healthcare's network. This must be done in a timely manner. This must be done 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. No services are covered outside the United States. Only emergency services requiring hospitalization in Canada or Mexico. Urgent care services are those services needed to prevent the member from getting worse. You can ask for interpreter services. This is at no cost to you. This will help in getting after hours care. Call toll-free (866) 449-6849 or CHIP Rural Service Area (RSA) (877) 319-6826.

Sometimes you or your child gets ill after hours. If you can, wait until the next day when the doctor’s office is open. You can also call our Nurse Advice Line toll-free (888) 275-8750 English; (866) 648-3537 Spanish; (800) 735-2989 TTY. 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 doctor the name of the urgent care center that you are to use. It is best to find out ahead of time. Ask your doctor the name of the urgent care center. Ask your doctor the name of the hospital that you are to use.

Emergency Care
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 help an emergency medical condition with severe symptoms. This can be severe pain. If immediate medical attention is not received​ right away, this may happen:

  • Member's health could be in serious danger.
  • Serious damage to bodily functions.
  • Serious harm to the body or body part.

Emergency health care includes urgent care services that cannot be delayed. This is 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 room.

When you go for emergency care (ER), carry your Molina Healthcare Member ID Card.

If you are not sure if you need emergency care, call your doctor or call our 24-Hour Nurse Advice Line toll-free (888) 275-8750 English; (866) 648-3537 Spanish; (800) 735-2989 TTY. 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. They must care first for those whose lives are in danger. Please do not go to a hospital emergency room if you do not have an emergency.

Second Opinions
Members who do not agree with a doctor’s plan of care can ask for a second opinion. They can ask from another Molina Healthcare provider. They can ask from an out-of-network provider. This service is free to the member.

Language Assistance
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:

  • (866) 449-6849 or CHIP Rural Service Area (RSA) (877) 319-6826
  • TTY English (800) 735-2989 or dial 711
  • Relay Texas Spanish (800) 662-4954

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