If you have a complaint, we encourage you to first call Member Services. We will try to resolve any complaint that you might have over the phone. If you request a written response to your phone complaint, we will respond in writing to you. If we cannot resolve your complaint over the phone, we have a formal procedure to review your complaints. We call this our Member Grievance Process.
You must file your grievance within 60 days of the event that gives rise to the grievance. You may file a grievance either orally or in writing, by one of the methods below.
For more information, Please call Member Services.
FAX: (562) 499-0610
Attn: Grievance and Appeals
P.O. Box 22816
Long Beach, CA 90801-9977
We will respond to all written grievances in writing. We will respond to oral grievances orally, unless you specifically request a written response. We will respond to all quality of care grievances in writing, regardless of how the grievance was filed.
Expedited Grievance Procedure:
You (or your representative, with appropriate authorization) are entitled to an expedited grievance whenever Molina Medicare takes an extension relating to an organization determination reconsideration, or when we refuse to expedite a request for an organization determination or reconsideration. Molina Medicare will respond to these grievances with 24 hours after receipt. Our expedited grievance determination will address only your dissatisfaction with our decision to take an extension or deny your request to expedite a determination or appeal. The grievance determination will not address the underlying issue (request for services or payment, etc.) that is the subject of the organization determination or reconsideration. For after hours, weekend, or holiday delivery please contact our Nurse Advice Line which is available 24 hours a day 7 days a week.
Standard Grievance Procedure:
For all other grievances, we will make a decision and notify you of our decision as your case requires based on your health status, but not later than 30 calendar days after receiving your complaint. We may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.
Medicare.gov Complaint Form
Click here for the Medicare Complaint Form.
You may also access additional information on Medicare's website at www.medicare.gov
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