Members

How to File an Appeal

An appeal is when you ask us to review a decision we made about an authorization. We may decide to deny, limit, reduce, or end an authorization for a service. This is called an Adverse Benefit Determination (ABD). An appeal tells us you want us to look at the information again to make sure we made the right decision.

You have the right to request an appeal within 60 days from the day you receive our Adverse Benefit Determination (ABD).

You may submit your appeal by phone, mail, or fax:

  • Phone: Contact our Member Services Department at 844-782-2018 (TTY: 711), from 8 a.m. to 6 p.m. CT, Monday through Friday.

  • Mail:
    Molina Healthcare of Nebraska, Inc.
    Attn. Appeals & Grievances
    Molina Healthcare, Inc.
    PO Box 182273
    Chattanooga, TN 37422

  • Fax: 1-833-635-2044

Be sure to include the following:

  • Member’s first and last name.
  • Molina Healthcare ID number. This is on the front of the Member ID Card Member’s address and telephone number.
  • Explain the problem.


We have a Member Appeal and Grievance Form you can use to file your appeal. Using the form will help you know the information we need.


Once you have submitted your appeal, Molina Healthcare will let you know we received your appeal and are working on it within ten (10) calendar days. Molina Healthcare will resolve the appeal as quickly as possible, but no more than thirty (30) calendar days from when we got your appeal. Molina Healthcare will let you know the outcome to your appeal in writing.

Expedited (fast) Appeals

If you feel that waiting 30 calendar days will put your health in danger, you or your representative may ask for an expedited (fast) appeal. You may need an expedited decision if not getting the treatment will cause:

  • Risk of serious health problems or death
  • Any serious problems with your heart, brain, lungs, or other body parts
  • Any serious problems with your mental health

When you submit your appeal by phone, mail, or fax, let us know if you think you need an expedited appeal.  We will send your request for review. If your appeal meets an expedited review, a decision will be made as quickly as your health requires and within 72 hours. You will have less time to give us information to support your appeal during an expedited appeal. Because of this, make sure to include any information to support your appeal when you send it to us. If your appeal does not meet the conditions for an expedited review, we will let you know.

If you think you need an expedited appeal decision, contact our Member Services Department at 844-782-2018 (TTY: 711), from 8 a.m. to 6 p.m. CT, Monday through Friday. 

Continuing benefits during appeal process

You can continue the services your provider has ordered for you while we look at your appeal.

If you would like to go on with your benefits while you are appealing, you must:

  • Let us know in 10 days from the date on the denial letter, or
  • Let us know in 10 days after the effective date of the action, whichever is later.

The appeal must be about an action resulting in a denial. An action is any denial that :

  • Limits Services,
  • Reduces Services,
  • Suspends Services, or
  • Terminated treatment that was previously approved.

If we decide to go on with your benefits, your benefits will go on until:

  • You withdraw the appeal.
  • Ten days (10) have passed from the date of the denial, and you have not asked for a State Fair Hearing.
  • The State Fair hearing makes a decision not in your favor.
  • The authorization for the benefits has ended or the limits are met.


If you asked to go on with your benefits and the decision is not in your favor, you may have to pay for the services that were given to you. Mail a letter, call, or fax the request to:

Molina Healthcare of Nebraska, Inc.
Att. Appeals & Grievances
Molina Healthcare, Inc.
PO Box 182273
Chattanooga, TN 37422