Members have the right to ask
for a Fair Hearing if they disagree with a decision made by Molina Healthcare.
A Fair Hearing can be requested at any time even if an appeal hasn’t been filed
with Molina Healthcare. A Fair Hearing
must be requested within 120 days from the date issued in the letter
from Molina Healthcare, stating services have been changed. If a Fair Hearing
is not requested within 120 days, rights to a Fair Hearing may be lost. To
request a Fair Hearing the member or member’s representative must contact
Molina Healthcare in writing or by telephone at:
Healthcare of Texas
Member Inquiry Research and Resolution Unit
(877) 665-4622 ext. 201050
Members have the right to continue any service being received
until the final hearing decision, if a Fair Hearing is requested within ten
(10) days from receipt of the adverse determination letter from Molina
Healthcare. If a State Fair Hearing is not filed within 10 days, the services
being appealed will be discontinued.
If a Fair Hearing is requested, a packet of
information with the date, time and location of the Hearing will be sent to the
member. Members may write or call toll-free at any time during the appeals
process (877) 665-4622 ext. 201050.
Most Fair Hearings are held by
telephone and the member or member representative will be able to discuss the
services being appealed.
Members can bring someone who
knows about the case to attend the hearing. Members may also bring someone else
to represent them. This person can be a doctor, a friend or a relative.
Texas Health and Human Services Commission will make a final decision within 90
days from the date that the Hearing was requested.