How to File an Appeal
An appeal is different from a complaint. An appeal is a request for us to review and change a decision we made about your services. If we sent you a Notice of Action (NOA) letter telling you that we are denying, delaying, changing, or ending a service, and you do not agree with our decision, you can ask us for an appeal. Your authorized representative or provider can also ask us for an appeal for you with your written permission. You must ask for an appeal within 60 days from the date on the NOA you got from us.
If we decided to reduce, suspend, or stop a service you are getting now, you can continue getting that services while you wait for your appeal to be decided. This is called Aid Paid Pending. To get Aid Paid Pending, you must ask us for an appeal within 10 days from the date on the NOA or before the date we said your services will stop, whichever is later. When you request an appeal under these circumstances, the services will continue.
You can file an appeal by phone, in writing or online:
- By phone: Call Molina Healthcare at 1-888-665-4621 (TTY/TDD or 711) between Monday - Friday, 7:00 a.m. - 7:00 p.m. Give your name, health plan ID number and the service you are appealing.
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By mail: Call Molina Healthcare at 1-888-665-4621 (TTY/TDD or 711) and ask to have a form sent to you. When you get the form, fill it out. Be sure to include your name, health plan ID number and the service you are appealing.
Mail the form to:
Attention: Member Appeals & Grievances
200 Oceangate, Suite 100 Long Beach, CA 90802
Your doctor’s office will have appeal forms available.
If you need help asking for an appeal or with Aid Paid Pending, we can help you. We can give you no-cost language services. Call 1-888-665-4621 (TTY/TDD or 711).
When will I find out that my appeal has been received?
Within 5 days of getting your appeal, we will send you a letter telling you we got it. Within 30 days, we will tell you our appeal decision and send you a Notice of Appeal Resolution (NAR) letter. If you file an expedited (faster) review, we will let you know within 72 hours.
Expedited (fast) Appeals
If you or your doctor wants us to make a fast decision because the time it takes to decide your appeal would put your life, health, or ability to function in danger, you can ask for an expedited (fast) review. To ask for an expedited review, call 1-888-665-4621 (TTY/TDD or 711). We will decide within 72 hours of receiving your appeal.
You can also read about these rights in your Member Handbook.