Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:03/25/2025

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Molina Healthcare incorrectly has that I have a different primary insurance. I have called multiple times to address this issue and nothing seems to be done. I have asked to speak to a supervisor multiple times and the representatives claim there is no supervisor available. This is causing a medication delay and is putting my health in jeopardy.

  Business Response

  Date: 03/27/2025

  We sent a letter member with the following wording:

  This letter is in response to your grievance Molina Healthcare received on 03/25/2025.  Your grievance is regarding the difficulty with you getting your medication due to other health insurance (OHI) being on file. You state your *** is no longer active and that you had difficulties with Molina ****************.
  
  Your grievance was researched. We reviewed your coverage and have confirmed you have primary coverage with ***** effective 12/14/2022 through current. We called Aetna and they confirmed this information.  If this is wrong, please provide documentation, a letter of credible coverage showing the correct information. You can send this information into us at the following: 
  
  Molina Healthcare
  Grievance and Appeals Unit
  P.O. Box 4004
  *****************
  Email: *********************************************************************
  Fax: **************
  
  We forwarded your concerns about Molina **************** to their management. Your calls will be reviewed. Coaching will be given as deemed necessary. 
  
  Please deeply apologize for the frustration in this matter.
  
  We would like to thank you for taking the time to call/write about your experience. Direct feedback from our members is very important and helps us improve.  We apologize for any trouble this may have caused you.
  
  If you have questions, please call Molina Healthcare at ************** (TTY 711) Monday through Friday from 7:30 a.m. to 6:30 p.m.
  

  We did call the **** Aetna and they stated the member's coverage was still active. Once the member gets the letter of credible coverage that states the other health insurance has ended, we can get her coordination of benefits updated. 

  Customer Answer

  Date: 03/28/2025

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ******* ****

• Initial Complaint

  Date:01/17/2025

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Molina Healthcare is an extremely bad company for what they call insurance they do the bare minimum and continually make you the patient jump through hoops to get any true coverage on anything. A great example is when it comes to filling prescriptions and getting coverage, I want to say just basked off of my experience that they force you to get a prior authorization for a huge majority of prescriptions, one such recent example is I literally just had surgery and when I went to pick up my antibiotics and pain medicine I was told I needed a prior authorization, heres the issue with that, you cant control or anticipate needing to have surgery or getting hurt so then why does Molina penalized the patient and make it hard for them to get the medicine they need, there practice on requiring prior authorization for everything and then denying coverage needs to end

  Business Response

  Date: 01/27/2025

  This is not a Molina Healthcare of Washington Member. The member is enrolled with Molina Healthcare in *********  We are unable to assist, however this was redirected to the ******** Healthplan to intake as a grievance and respond to member's concerns. We are closing this matter. 

• Initial Complaint

  Date:10/08/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My son has ****************** Genetic cause of Developmental Delay and Autism) SSA has me as his ***resentative Payee, *** and Consumer Direct has me as his Authorized ***resentative. The Superior Court of Washington in ************* has given me full unlimited Guardianship and Conservatorship to support him. Applehealth/********, DDA, DSHS, and DVR of Washington state all have copies of his Guardianship papers. However, he has a doctor appointment with a **************** (Closest one to us) in ************** **. I was unaware that they didn't have me listed as his Guardian and when I called to confirm Pre Authorization they refused to talk to me. They gave me a fax number which I faxed the Guardianship papers to and it was not a fax number so it didn't work. I contacted a Molina *** for the state of Washington through ****************************** of **************************************************************** *** gave me the same "fax" number which goes to a ******** Life Alert Automated Phone system and is not a fax number. I created a Portal at the Molina website for my son and uploaded the documents into that. The email said that I would hear back within one business day. The Molina *** advised me I would be called later that same day. It's now been over one business day and I haven't heard back. I have spent about 10 hours in the last 3 business days just trying to get this paperwork to Molina so that I can even get to Step 1 of discussing my son's healthcare with them. Our appointment is in 6 business days so I don't have enough time to mail it to them and wait for them to process it. Had I known sooner I would have mailed it. However, they advised me through chat and on the phone that I can fax it but have repeatedly given me a number that is not a fax number. My complaint is that they are making it too difficult to communicate with them and to submit paperwork to them in a timely manner. They are saying they will take it through fax but even their own employees give the wrong fax number.

  Business Response

  Date: 10/11/2024

  To first address the contacts made by the mother to Molina's Member Services Team, we show they sent a message through the My Molina Portal Application on 10/07/2024, with the Guardianship Decree. This was acknowledged as 'received' and was forwarded to the appropriate department for processing. The decree was loaded to the account with an effective date range 05/15/2023-02/14/2026.
  
  The mother then called on 10/08/2024 about their son's referral status. They were advised to contact the referring physician's office about the referral, as Molina did not receive any information. The referrals are 'Provider-to-Provider' and not reviewed by Molina Healthcare. If services require Prior Authorization to show Medical Necessity before the services are rendered, this request would be reviewed by a Medical Director at Molina Healthcare.
  
  On 10/08/2024, the mother sent a message through the My Molina Portal with similar details provided in the complaint received through the BBB. On 10/09/2024, a response was sent back to the mother, requesting their information to identify who had sent the message and to determine if they were authorized to access the member's account in question. They did not include proper identification for our Member Services Team to access the account or release information.
  
  To next address the appointment scheduling and referral. There were no Prior Authorization (PA) requests received by either the member's Primary Care Physician (PCP) or the specialty provider group in Utah. I contacted (University Developmental Assessment Clinics) at (Phone: 801-587-2255) spoke with (Lisa) in scheduling.
  
  I advised that I was needing to verify if referral for mutual patient was received and if they were planning to submit PA. The member has active Medicaid coverage, however for Out of State (OOS) they only have Emergency (ER) and Urgent Care (UC). These services seem to be physician related and Behavioral Health/ Mental Health.
  
  (Lisa) stated they have spoken with the mother of this patient a few times. They are not aware of any Prior Authorization (PA) requirements and suggested that they speak with Billing. (Lisa) stated they transferred them (mother) to billing and it looks like they (mother) cancelled appointment on 10/09/2024.
  
  I commented that billing likely said they would not submit PA and these services would be Out-of-Pocket (OOP), patient responsibility. It is unclear if that is what was advised.
  (Lisa) stated they were unsure too and can't give out information on account as the patient is over 18.
  I thanked (Lisa) for information, no further questions.
  
  We have submitted a Resolution Letter to the mother of this member to advise of HIPAA Regulations with Protected Health Information (PHI), that we received their Guardianship Decree and is 'active' from 05/15/2023-02/14/2026. Their son is reflecting as 'Head of Household' (HOH) in the Washington Healthcare Authority (HCA) system, due to their age being over 18 years. We have advised the mother will need to contact the HCA as well to provide the Guardianship Decree and request changes to the HOH, so that the state file is reflecting accurately. The state file is submitted to Molina Healthcare when changes are made, as the state determines eligibility. This change is an example of the state file having information that Molina directly mirrored.
  
  Within our Resolution Letter, we have also given information on our call to the physician group in Utah. They will need to contact their primary care physician (PCP) that they have established care with, to determine if they will provide 'Continuity of Care' or have a referral to a provider within the state of Washington, that supports this member's medical needs. Our members' have access to a list of Provider's through the Molina Healthcare website and their My Molina Portal account. They are able to search by specialty, distance, gender, language and can further filter by 'Accepting New Patients'. We will attempt to locate providers through the POD and send the appropriate information with our Resolution letter, so the mother of this member can verify availability and transition care if necessary.

• Initial Complaint

  Date:08/30/2024

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My concerns are whether the following issues are legal and to report denial of medication coverage:Molina denied coverage for an extra 30 day supply of medication needed while traveling. The prescribing physician submitted an order to the pharmacy. The explanation was that one override is allowed annually and that I had made this request once already during 2024.My second concern: Molina insurance asked that I provide where I would be traveling. This information has never been asked of me by other health insurers. I have been working on this issue with Molina, the physician, and the dispensing pharmacy Caremark CVS for 2 weeks. Molina insisted repeatedly that I provide where I would be traveling but could not explain why this information was necessary. I provided my travel plans and was then told that I am only allowed one override per year (as described above) and that Molina would not provide the requested additional 30-day supply. -Is it legal for a pharmacist to ask about personal travel plans if the medication has nothing to do with a location for travel but is necessary for a health condition?-Is it legal to deny the added 30-day supply? Molina advertises a client can receive 90 days, so it seems there are two concerns herecoverage and misleading the client.-How is this type of request handled for someone whose work involves travel?I will be taking a risk by traveling without this medication.Sincerely,*****

  Business Response

  Date: 09/09/2024

  This issue has been resolved internally and a response has been provided to the customer. Due to HIPAA concerns we cannot provide additional information through this medium. Please call Molina for additional information.

• Initial Complaint

  Date:08/02/2024

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I pay almost $1200/month for an individual Molina Cascade Gold plan because I wanted the best, most complete coverage. I expected to pay $40 copay for specialist visits. My specialists (endocrinologist, gynecologist, rheumatologist) work in clinics inside larger buildings (as do most physicians). I am healthy, have had no procedures done, simply yearly checkups so my prescriptions can be renewed and to monitor my health. It turns out that Molina will not cover any facility fee, rendering my required co-pays for certain doctors not $40 but up to an additional $350. And even though I have paid my deductible they will not cover this. If I had had day surgery I could perhaps understand this, but we are talking a 15 minute-30 minute simple check-up. It seems Molina would only honor the $40 specialist co-pay if my doctors were setting up shop on the sidewalk, but not in an actual office. In other words, this seems classic bait and switch, promising a $40 co-pay, but demanding up to $390. This is outrageous. When I have complained, Molina has said the billing office needs to use some alternate code they couldn't tell me (i.e. they don't know the code that would get this covered). One Molina *** even had the gall to ask why on earth I would need to see a gynecologist! So, they refuse to deal with this. I have already complained to the WA state insurance commissioner but in the past that hasn't resolved things. Now I am being hounded to pay the outstanding bill and I will have to if I don't want to be referred for collections. Molina should be prevented from operating this way.

  Business Response

  Date: 08/13/2024

  It was determined that the charges mentioned are appropriate as per the member's plan and this has been previously explained. A more complete response has been sent to the concerned party directly.

• Initial Complaint

  Date:05/06/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Molina discretely canceled my insurance without notice, and after telling me that I would be covered until the end of May.They ended it without telling me on 04/30/24, leaving me unable to get my medications. When I tried to speak with someone about the matter, I was told I had to wait 2-4 days for a supervisor to call back.I have a daily medication that is needed, so that amount of time to speak with someone is inexcusable. I told them that my medication was required for me to live, but that didn't change one thing. They ended up hanging up on me.

  Business Response

  Date: 05/15/2024

  Customers Statement of the Problem:
  Molina discretely canceled my insurance without notice, and after telling me that I would be covered until the end of **** They ended it without telling me on 04/30/24, leaving me unable to get my medications. When I tried to speak with someone about the matter, I was told I had to wait 2-4 days for a supervisor to call back. I have a daily medication that is needed, so that amount of time to speak with someone is inexcusable. I told them that my medication was required for me to live, but that didn't change one thing. They ended up hanging up on me.

  I called ***** to ask him some questions along with explain to him the process for renewing coverage.
  

  I explained to ***** that Molina is a state ******** MCO ************* Organization)meaning that Molina doesnt determine eligibility for members. Because we are managed by the state or The *** they are the ones who determine coverage and update members eligibility. Starting at the beginning of this year the US determined that we are no longer in the ***** pandemic, therefor due to the pandemic being lifted ******** eligible recipients have to call to renew their coverage.During the pandemic this was waived, and ******** eligible members were automatically having their coverage renewed without having to do anything. This is no longer the case and people have to make the call to renew if they want to continue with their ******** coverage. I did a lot of research and calling different departments to figure out why your coverage termed early however, I couldn't find an answer as to why it termed early.
  
  Molina has a department called HealthPlan Renewals who helps with the renewal process. I called them to see if they knew why it termed early and they informed me that they arent able to share information like that with me, but they do know why it termed. They advised me to call ***** and transfer to them so they can explain and further assist him in renewing his coverage.

  ***** informed me that he had already called Molina's Healthplan ******************** His coverage was set to term at the end of May, he got a letter in the mail from Molina saying his coverage was going to term and to call Molina's HealthPlan ****************** to renew his coverage. ***** was being proactive and called Molina at the end of April, when he got the letter. When he called Molina's renewal department, they informed him that he made too much and that he didn't qualify for coverage for **** This is why the coverage termed a month earlier than expected for ***** is because ***** actively called to renew his coverage and didn't qualify. ***** is now upset that he was doing his due diligence and trying to be proactive with renewing his coverage and it led to him not qualifying for coverage for *** when originally his coverage wasn't going to term until the end of **** Molina didn't discreetly term his coverage without him knowing as ***** called Molina's ****************** and was advised he didn't qualify for coverage for the month of May, which has led to him not fill his medications in ****

  Customer Answer

  Date: 05/31/2024

  I'm at a loss as to how my complaint has been swept under the rug.  Can someone please explain that to me?

• Initial Complaint

  Date:04/24/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Molina's ******** Advantage program has called me nearly every business day since the start of April 2024 (it is now April 24th) to ask if I wanted to switch to their program. I have said no. Repeatedly. They will not stop calling. I told them to remove me from their list and their response was to offer once again for me to switch. The representative I talked to spent the entire call of me telling them to stop calling me to try to convince me to switch into their program despite repeatedly saying no I don't want this.Included is dated screenshots going back several days of my call record from them

  Business Response

  Date: 05/06/2024

  Regarding: DO NOT CALL LIST REQUEST

  This letter is in response to your grievance Molina Healthcare received on 04/24/2024.
  Your grievance is regarding your request to no longer receive calls from Molina
  Marketplace.
  Your grievance was researched. Please be advised that we have forwarded your request to
  our ****************************** leadership to no longer be called at *************.
  Our records have been updated with your phone number ************* placed on our Do
  Not Call (DNC) list.
  We would like to thank you for taking the time to call/write about your experience. Direct
  feedback from our members is very important and helps us improve. We apologize for
  any trouble this may have caused you.
  If you have questions, please call Molina Healthcare at ************** (TTY 711)
  Monday through Friday from 7:30 a.m. to 6:30 p.m.
  Sincerely,
  ************
  Appeals and Grievances, Specialist
  Molina Healthcare of Washington

• Initial Complaint

  Date:02/02/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  After waiting months to have surgery on my shoulder...a week before my surgery, my surgeon called and told me that they had to cancel my surgery because Molina would not reimburse **************** enough for a portion of my surgery. This company does not understand that their decisions to make more money affects REAL PEOPLE. I am in pain 24 hours a day, 7 days a week from a total AC Joint Separation and Molina Healthcare literally told me 'sorry, there is nothing we can do'.

  Business Response

  Date: 02/16/2024

  Issue resolved with member over the phone. The provider is not participating with this plan and as such requires authorization. No further information can be provided as per HIPAA.

• Initial Complaint

  Date:01/24/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Molina was billed for service I have received but won't pay the balance although I was covered during the time frame in question. Molina has been paid a retroactive payment to ensure the bill could be successfully submitted. They have been uncooperative regardless of payment and I the customer have been held liable to pay for a service I was covered with healthcare. I've contacted the billing compliant **** as well and trying to open a hearing to resolve this matter. All efforts are going ignored and this business is unfair and unreliable in a time of need even after they have received payment

  Business Response

  Date: 02/01/2024

  Hello,

  The coverage for (**********************) was reflecting the records of Washington Healthcare Authority. It was confirmed that updates were made to allow active coverage from (05/01/2020-06/30/2021) and again (07/01/2021-12/31/2023).

  Molina Healthcare made the appropriate changes in these eligibility segments to reflect active coverage. We discovered several provider/ physician claims on file during these date spans, that required Adjustment. We have since sent the claims to be adjusted, which will take ***** days for processing and for the provider(s) to receive payment information. We have already contacted the provider/ physician group (MULTICARE HEALTH SYSTEM) that (**********************) was receiving active billing notices from. This provider group (MULTICARE HEALTH SYSTEM) advised they have notated their records and requested that (**********************) disregard the bill.

  We have provided this information to (**********************) and given information about their right as a ******** recipient for balance billing. We have provided them with contact information for Molina Healthcare, if they continue to experience issues with their provider group.

  Thank you, for the opportunity to address this concern. If you have any questions regarding this information, please do not hesitate to contact back.

  -Autumn H. | Specialist, Member Appeals and Grievances | Molina Healthcare of Washington, ********

• Initial Complaint

  Date:12/20/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  They have always had an issue with trying to add a primary insurance. There isnt one. They usually remove it same day. Dec 7 I started getting denials of claims. An agent filed to have it looked into but never actually turned it in. My son had major surgery and they are covering nothing. They say we have some other health care coverage. We do not. Their representative a supervisor called with me on the line, to this insurance place the supposed to have verified coverage thru. I gave ALL my information they dont even do insurance! They are a pension company! Its been weeks no resolution no nothing. I have kids running out of medicine, kids that need to be in physical therapy. They cant keep a straight story, they cant get the name of this imaginary insurance. They are rude when you try to get help. They just basically say too bad! I have spoken to apple health who says no other insurance is on me or my children. They pay my premiums. They really need to get it together.

  Business Response

  Date: 01/16/2024

  Thank You for bringing this *** issue to our attention regarding our members *********************** and her children. We have reviewed all of their accounts including the accounts of all of Mrs. ***** children and it appears that we are showing the *** ZENNITH ADMIINISTRATORS as active within her account and most of her childrens accounts from 11/01/2023 through 11/30/2023. We are now also showing the *** as being reinstated within their accounts from 01/01/2024 01/31/2024. This issue was escalated to our enrollments department to address, and we were able to successfully connect with a representative at Zennith Administrators who confirmed that ************* and her children were active from 11/01/2023 11/30/2023 and that their coverage was reinstated on 01/01/2024 01/31/2024. I have contacted ************* and advised her of this, and at this time she is also going to contact ******* Administrators directly to get the proper documentation and ID cards as she was not aware of this primary coverage for her and her children. We will also be addressing any claims that have *** have been affected due to this ***. Thank you again for allowing us to address this issue. Please let me know if you have any questions or need anything further.
  

  Attached is the letter we also sent to **************

  Below are the names of the children who's accounts had primary insurance that we have updated.
  

  ****************** W
  ****, HYNTER J
  ************************ L
  ****, ******** S
  LITTLE, LYLEAH E
  ****************************** D
  
  Thank You,