How Do I?
Let’s get to know more about your Molina Healthcare (Molina) health plan and benefits
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Where do I go to get healthcare? |
When should I go to the emergency room? What is an emergency? Call 911 or go to the ER for:
If you aren’t sure you have an emergency, you can call the Molina Healthcare (Molina) Nurse Advice Line.
If you aren’t sure if you should wait to see your PCP, call the Nurse Advice Line and ask. You can reach a nurse or behavioral health professional 24 hours a day, 7 days a week to answer your health questions. If you do go to the ER, remember to:
When to see your PCP Examples of non-emergencies:
If your PCP is closed or not available, please consider going to a local in-network urgent care clinic for issues that are non-emergencies. Your Care Coordinator can assist you with finding an urgent care clinic in your area. Behavioral Health Crisis Behavioral Health Crisis Line (available 24/7/365) Suicide and Crisis Lifeline 988
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How do I request coverage? |
There are some treatments, services and drugs that require approval from us before you can get them. This is called a service authorization. You or your doctor can ask for a service authorization. Call Member Services to ask if a service or treatment needs a service authorization. After you or your doctor asks us for a service authorization, we review the request to decide if the treatment is medically needed and right for you. We will let you know if the request is approved within 14 calendar days. If waiting more than 14 days could seriously harm your health, your doctor can ask us to do an expedited review. If your doctor asks for an expedited review, we will let you know if the request is approved within 3 calendar days, or as quickly as your health condition requires. If you disagree with our decision, you can file an appeal. You can read more about how to do that on this page. Look in your Member Handbook for more information about service authorizations. |
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How do I file an appeal or grievance with Molina Healthcare? |
What is an appeal? An appeal is a way for you to challenge an adverse benefit determination (a denial or reduction in benefits) made by Molina Healthcare (Molina) if you think we made a mistake. You can ask us to change our decision by filing an appeal. What is a grievance? A grievance is a complaint you make about us or one of the providers or pharmacies in the Molina network. This includes a complaint about the quality of your care. How do I file an appeal? You can file an appeal by phone or in writing. You can send your appeal as a standard appeal or an expedited (fast) request. Check your Member Handbook for complete instructions on how to file an appeal. How do I file a grievance? An external grievance is a complaint you make to the state or a state agency about Molina or one of our network providers or pharmacies. Check your Member Handbook for complete instructions on how to file a grievance. |
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How do I report Fraud, Waste and Abuse? |
Molina Healthcare’s Fraud and Abuse Plan benefits Molina, its employees, members, providers, payers and regulators by increasing efficiency, reducing waste, and improving the quality of services. Molina Healthcare takes the prevention, detection, and investigation of fraud and abuse seriously, and complies with state and federal laws. Molina Healthcare investigates all suspected cases of fraud and abuse and promptly reports to government agencies when appropriate. Molina Healthcare takes the appropriate disciplinary action, including but not limited to, termination of employment, termination of provider status, and/or termination of membership. You can report potential fraud, waste and abuse without giving us your name.
To report suspected Medicaid fraud, contact Molina Healthcare AlertLine at: Toll free, (866) 606-3889 Or Complete a report form online at: MolinaHealthcare.alertline.com
Definitions: “Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (42 CFR §455.2) “Fraud” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit for them or some other person. It includes any act that constitutes fraud under applicable Federal or State law. (42 CFR § 455.2)
Here are some ways you can help stop fraud:
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How do I change my PCP with Molina? |
You can change your primary care provider (PCP) with Molina at any time. To choose or change your PCP go to the Member Portal or call Member Services at (833) 685-2102 (TTY 711.) It is possible that your PCP might leave our network. If this happens, we will tell you within 15 days from when we know about this. We can help you find a new PCP right away. |
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How do I get a new Member ID card? |
If you have not gotten your Member ID card, or your card is damaged, lost or stolen, call Member Services right away and we will send you a new card. Member Services
You can also log in to the Member Portal and request a new Member ID card under “Member ID Card”. |
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How do I complete my Health Risk Assessment (HRA)? |
It is important for you to take your Health Risk Assessment (HRA). Your answers will help us understand your needs and allow us to provide you with the best level of care. You can complete your Health Risk Assessment via the Member Portal under the Health Record tab. |
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How do I follow a care plan? |
An individualized care plan includes the types of health services that you need and how you will get them, as well as your personal goals for your health. It’s based on your Health Risk Assessment (HRA) and individual needs and goals. After you complete your HRA, your care team will talk to you about what kind of healthcare you need. They will also ask you about your goals and preferences. Together, you and your care team will make a personalized care plan, specific to your needs. Your care team will work with you to update your care plan when your healthcare needs change, and at least once per year. You can find your care plan, if applicable, in your Health Record in the Member Portal.
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How do I set up a ride to my appointments? |
Do you need a ride to your healthcare appointments? We can get you there! Please contact MTM to schedule a ride: You can also call Member Services at (833) 685-2102 (TTY /TDD: 711.) You must give at least 5 working days’ notice when scheduling transportation.
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