How to Appeal a Denial
You have the right to appeal a denial.
What is a denial? A denial means Molina Healthcare is informing you and your provider that services and/or claims will not be authorized or paid. If we deny your service or claim, you have the right to request an appeal of the denial. An "appeal" is the request for a review of an action.
If your service or claim is denied, you will get a letter from Molina Healthcare telling you about this decision. This letter, called a Notice of Action (NOA), will tell you about your right to appeal and file a state hearing. You can also read about these rights in your Member Handbook.
The Member Services staff can also help you to file an appeal over the phone. They can also assist you in filing a grievance if you are not happy with the decision of your appeal for a disputed healthcare service. You can also ask for assistance in filing a state hearing.
How to Appeal a Denial
If you receive a Notice of Action (NOA) from Molina Healthcare, you have three (3) options for filing an appeal. A Notice of Action (NOA) is a formal letter telling you that a medical service has been denied, deferred, or modified.
- Members have ninety (90) days from the date on the Notice of Action to file an appeal with Molina Healthcare. Members may file an appeal in person, in writing, fax, TTY/TDD or telephone. We will send the member a letter acknowledging receipt of the appeal within three (3) working days. Your appeal will be processed and a determination will be made no later than 15 calendar days from the date the appeal was received.
- Members may request a State Hearing from the Bureau of State Hearings (BSH) within ninety (90) days from the date on the NOA.