Molina Healthcare of Michigan, Inc. claim denials in Michigan: the federal figures
Molina Healthcare of Michigan, Inc. denied 15.2% of in-network claims in Michigan — 20,063 claims out of 132,379. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Molina Healthcare of Michigan, Inc.) | 167 | 29.3% |
| External review (independent) | 18 | — |
What Molina Healthcare of Michigan, Inc. denies most
The most common denial reason recorded for Molina Healthcare of Michigan, Inc. plans in Michigan is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 15,055 | 26.6% |
| Service excluded from the plan | 13,564 | 23.9% |
| Benefit limit reached | 9,175 | 16.2% |
| Other reasons | 7,109 | 12.6% |
| Referral required | 6,648 | 11.7% |
| Provider out of network | 3,710 | 6.6% |
| Experimental or investigational | 617 | 1.1% |
| Not medically necessary | 582 | 1% |
| Member not covered | 180 | 0.3% |
What to do if Molina Healthcare of Michigan, Inc. denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Molina Healthcare of Michigan, Inc. overturned 29.3% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Molina Healthcare of Michigan, Inc.. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Molina Healthcare of Michigan, Inc. appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Molina Healthcare of Michigan, Inc.'s denial rate high?
15.2% against a national average of 16% across the plans in this dataset. It is at or below average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Molina Healthcare of Michigan, Inc. ignore the external decision?
No. External review decisions are binding on the plan.