Independent Medical Review
Independent Medical Review
If you requested an appeal and got a NAR letter telling you we did not change our decision, or you never got a NAR letter and it has been past 30 days, you can file an Independent Medical Review/Complaint form with the Department of Managed Health Care (DMHC) to have Molina Healthcare’s decision reviewed. Or ask for an Independent Medical Review (IMR) from DMHC.
An IMR is when an outside doctor who is not related to your health plan reviews your case. If your complaint qualifies for DMHC’s Independent Medical Review (IMR) process, an outside doctor who is not part of Molina Healthcare will review your case and make a decision that Molina Healthcare must follow. DMHC’s toll-free telephone number is 1-888-466-2219 (TTY 1-877-688-9891). You can find the Independent Medical Review/Complaint form and instructions online at the DMHC’s website: https://www.dmhc.ca.gov.
You must ask for an IMR within 6 months from the date on the notice telling you of the appeal decision, but you only have 120 days to request a State Hearing so if you want an IMR and a State hearing file your complaint as soon as you can. Remember, if you ask for a State Hearing first, and the hearing has already happened, you cannot ask for an IMR. In this case, the State Hearing has the final say.
You will not have to pay for a State Hearing or an IMR.
You can also read about these rights in your Member Handbook.