Molina Healthcare Appeal Help
Molina Healthcare Denied Your Claim? How to Appeal
Your Molina plan type sets your appeal deadline and route; your denial letter states both.
Free, always. No account. You review every word before you send it — and we never send anything to your insurer. You do.
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Quick Answer
Many Molina members have a Medicaid plan. Appeal to Molina within 60 days of the date on the notice (42 CFR 438.402(c)(2)(ii)); to keep a service you already receive while you appeal, file within 10 days (42 CFR 438.420). If Molina upholds the denial, ask your state Medicaid agency for a fair hearing (42 CFR 438.408). Molina Medicare plans follow Medicare’s rules, and Marketplace plans follow the federal claims rules plus your state’s external review. AppealArmor drafts the appeal letter from your denial letter, free and with no account.
Which Molina plan do you have?
Your plan type decides the rules, the deadline and where you complain. It is printed on your member card and your denial letter.
Medicaid or CHIP plan
Appeal to Molina within 60 days of the date on the notice (42 CFR 438.402). If Molina upholds the denial, ask your state Medicaid agency for a fair hearing; you have 90 to 120 days from the plan’s appeal decision, depending on your state (42 CFR 438.408(f)(2)); the plan’s decision letter states your deadline. Complaints go to your state Medicaid agency.
Medicare plan
Ask Molina to reconsider within 60 days of receiving the notice (42 CFR 422.582). If Molina upholds a denial of care, it must send your case to an independent review entity (42 CFR 422.590). Complaints go to 1-800-MEDICARE (1-800-633-4227) or the Medicare.gov complaint form, not your state insurance department.
Marketplace (individual) plan
You have at least 180 days to file an internal appeal (45 CFR 147.136), then an external review by an independent reviewer. Complaints go to your state insurance department.
Medicaid rules that help your appeal
Keep your care during the appeal
If Molina is reducing, suspending or ending a service it already approved, file your appeal within 10 days of the notice (or before the change takes effect, if that is later) and ask for your benefits to continue (42 CFR 438.420).
Check Molina against your state’s Medicaid rules
Molina runs your Medicaid benefits under a contract with your state. Ask Molina for the criteria it used and compare them with your state Medicaid program’s coverage rules for the service.
Children under 21
Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit requires coverage of medically necessary care for enrollees under 21, even when the state plan does not otherwise cover it (42 U.S.C. 1396d(r)(5)).
Notices you can read
Denial notices must be available in your state’s prevalent non-English languages, and oral interpretation must be available in any language at no cost (42 CFR 438.10(d)). If you could not read your notice, say so in your appeal.
How AppealArmor Fights Your Molina Denial
Upload Your Molina Denial Letter
Upload the denial letter from Molina Healthcare. AppealArmor reads the denial reason, plan details and appeal deadline, and you confirm every detail before anything is written.
We Find the Federal Rules for Your Plan
AppealArmor cites the federal appeal rules for your type of plan from the eCFR, plus state law where it applies, and names the agency that oversees your plan. It does not use insurer-specific research.
Download Your Appeal Packet
Your packet is the appeal letter (Word and PDF) and a Next Steps sheet: where to send it, your deadline as your letter states it, who to copy, and who to contact if it is denied again.
Frequently Asked Questions
How long do I have to appeal a Molina Medicaid denial?
60 days from the date on the notice to appeal to Molina (42 CFR 438.402(c)(2)(ii)), or 10 days if you want a service you already receive to continue during the appeal (42 CFR 438.420). The deadline in your denial letter controls.
Can I go straight to a state fair hearing?
Usually not. You can ask for a state fair hearing after Molina upholds its denial on appeal, or if Molina misses its own appeal deadline (42 CFR 438.408(f)(1)).
How do I appeal a Molina denial?
Send Molina a written appeal that answers the reason on the denial, with your doctor’s letter and records. AppealArmor drafts that letter and cites the federal appeal rules for your type of plan, plus state law where it applies. It does not use insurer-specific research.
Does AppealArmor work for Molina denials?
Yes. AppealArmor reads your Molina Healthcare denial letter, asks you to confirm every detail, and drafts an appeal letter that answers the stated reason and cites the federal appeal rules for your type of plan, plus state law where it applies. It does not use insurer-specific research, enforcement history or case law.
Appeal your Molina denial
Upload your Molina Healthcare denial, check every detail we read from it, and get an appeal letter that answers the denial and cites the federal appeal rules for your plan, plus state law where it applies.
Start my appealFree, always. No account. You review every word before you send it — and we never send anything to your insurer. You do.