Members

How to File an Appeal

Appeals

If you receive a denial letter and do not like the choice we made, you can file an appeal. An appeal is a request to review an action or denial. An action is any denial that is:

  • Limited

  • Reduced

  • Suspended

  • Terminated, or

  • Payment is denied

Filing an Appeal

All appeals must be filed in 60 days from the day of the denial. If you call, you may be asked to send more information in writing. To file your appeal, you can:

  • Call Member Services at (844) 236-0894 (TTY/TDD: 711)

  • Write a letter to:
    Molina Healthcare of Iowa
    PO Box 3010 
    Des Moines, IA 50393

  • Send a fax to (888) 832-1922

If you need a copy of the Appeal Request Form you can call Member Services or download and print a copy. We can help you write your appeal. Your appeal request needs:

  • Your first and last name

  • Your Molina ID number on the front of your Member ID Card

  • Your address and telephone number

  • An  explanation of the problem

We try to solve your appeal right away. Your appeal is looked at by the Grievance and Appeals Department. A letter is mailed to you in three (3) days. This letter lets you know we have received your appeal and we will tell you when we expect to resolve your appeal. The reviewer will note and take care of your appeal. The reviewer will work with the right departments to solve your appeal. For standard appeals, we will mail our decision in 30 days from the day we received it or as expeditiously as your health requires. The timeframe to resolve your appeal may be extended by an additional 14 days if you request an extension or if additional information is needed. We will write you and tell you that we have requested an additional 14 days and the reason for requesting the additional time. For expedited appeals, we will mail our decision in 72 hours from the day we receive the request.

To be fair, cases will not be looked at by the same person that made the first decision. All appeals about medical services are reviewed by our medical staff.

Expedited or Rushed Appeals

 

An expedited or a rushed appeal is when waiting for a regular appeal may risk your life or health. All rushed appeals will be solved in 72 hours or as quickly as your health condition requires but no more than 72 hours from the date of the request for a rushed appeal.

Filing a Rushed Appeal

You, your doctor or someone else, with your approval in writing, may call or write to ask for an appeal to be rushed. We can help you with this. Molina will decide if your appeal meets the requirements for a rushed review.

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You, your Provider or an Authorized Representative may file a rushed appeal within 10 calendar days of the date the adverse benefit determination was received. We will give you a verbal decision on a rushed appeal within 72 hours. We will follow up in writing in 2 days of receiving it.

To file an expedited appeal please follow the same process outlined above under “Filling an Appeal”.