Questions and Answers
Q. How do I get medical services?
A. Molina Community Plus will take care of your health care and long term care needs. We will help you and your families choose the right care for you. Most of your medical services are done through your primary doctor and covered through Medicare. Please contact your case manager directly or call Member Services at (866) 472-4585 for help.
Q. How do I get translation services?
A. If you prefer to speak in your own language, Member Services can help. There is no cost to you. Call Member Services at (866) 472-4585. If you are hard of hearing, call our TTY line at (800) 955-8771. An interpreter will be available to speak with you. If you have an appointment, your doctor can help you find an interpreter. They can also help you speak to the doctor. An interpreter can help you:
- Make an appointment.
- Talk with your doctor or nurse.
- Get emergency care.
- File a complaint, grievance or appeal.
- Get help from a pharmacist about taking medicine.
Q. What is a prior authorization?
A. When an approval is needed, it is called a “prior authorization”. Your primary doctor or case manager will take care of any authorizations you need. In order for services to be covered by Molina Healthcare, you must follow procedures as outlined in your Member Handbook to ensure the services are authorized. There are two types of covered services:Home and Community Services are provided according to the member’s care plan. The Case Management Department develops the care plan based on an assessment and other information. We work with you and your family/caregiver to improve your quality of life and keep you functioning at home for as long as possible. All home and community services address your health and social needs as outlined in your plan of care and authorized by your case manager.
Medical Services are covered when they are determined to be medically necessary and are authorized by Molina Healthcare. However, you will receive most of your medical services from the Medicare program. Molina Healthcare is responsible for any copayments or deductibles for covered Medicare services that are also Medicaid covered services. Molina Healthcare does not pay for non-covered services or services provided by a non- Medicaid/Medicare provider. If you need to copy or to discuss our authorization, a description of our authorization process is available upon request. You may call Member Services or your case manager to request for the process in writing.
Q. Who can I call with questions, concerns or complaints?
A. Molina Healthcare will provide you with a case manager who will have direct contact with you and your family. They will discuss the services you need with you, your caregiver and your primary doctor. Please contact your case manager directly.
Our Member Services team can also help you. Call us at (866) 472-4585, Monday to Friday, 8 a.m. - 7 p.m. Our staff is bilingual and can answer any questions that you may have about your health plan benefits.
Q. How does Molina Healthcare look at new services?
A. Molina Healthcare uses a medical evaluation process to assess whether a new drug, medical device, medical, surgical or behavioral health protocol/procedure or other therapy is proven to be safe and effective for a particular clinical indication or condition when compared to alternative therapies. The goals of this process are:
- To review and update coverage decisions as new scientific evidence becomes available.
- To review individual cases to evaluate whether or not to cover a specific request service.
If Molina Healthcare denies coverage for a drug, device, protocol, procedure or other therapy that is a new technology that is not a medically necessary Medicaid-covered service, you or your provider can ask for information on Molina Healthcare’s coverage protocols and procedures. For more information about our internal assessment process, please call Member Services at (866) 472-4585 or (877) 955-8773 for Spanish or (800) 955-8771 for TYY for the hearing impaired.
*Printed copies of information posted on our website are available upon request.
Q. How do I get behavioral health services?
A. Medicare primarily covers these services. Please call your case manager directly or Member Services at (866) 472-4585 for help.
Q. When do I get my new Member Handbook and Member ID Card?
A. You should receive your Molina Healthcare Community Plus Member Handbook, Provider Directory and Molina Healthcare Member ID Card the first week after your enrollment is effective with Molina Healthcare.
Q. What if I need a dentist?
A. If you need dental services, you must get care from any dentist who accepts DentaQuest. To find the nearest dentist in your area, you may call DentaQuest at (888) 696-9541. For TTY, call the Customer Service Helpline at (800) 466-7566.
Q. What if I need vision care?
A.As a member of Molina Healthcare, your vision care is provided to you by March Vision Care. To find the vision care center nearest you, call (888) 493-4070. You may also visit the March Vision Care website at www.marchvisioncare.com.
Q. How do I make an appointment?
A. Please call your doctor’s office directly to make a medical appointment or to change an appointment. If you need assistance scheduling appointments, call your case manager. If you need care after hours or urgent care, contact your primary doctor. Your primary doctor’s office may send you to an after-hours clinic or urgent care center. You may also contact our 24-hour Nurse Advice Line at (888) 275-8750.
Please contact us if you cannot get an appointment when you need one. You may call Member Services at (866) 472-4585 for help.
Q. How do I join Molina Community Plus?
A. If you qualify for Medicaid and want to become a member: Broward County: Call Choice Counseling at (866) 454-3959. All other counties: Call Medicaid Options at (888) 367-6554.