Molina Healthcare of Ohio denied your claim. Here is your deadline.
Put in the date on your Molina Healthcare of Ohio, Inc. notice and get both federal deadlines as calendar dates.
Free, for a Molina Healthcare of Ohio, Inc. denial in Ohio, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
Molina Healthcare of Ohio, Inc. denied 428,806 of 1,975,213 in-network claims in Ohio; every one of those denials had these same two dates on it. Across Ohio as a whole the insurers in this file denied 17.9% of in-network claims, 2,934,307 of them, and 35,236 were appealed.
Molina Healthcare of Ohio, Inc. denied 21.7% of in-network claims in Ohio, 428,806 claims out of 1,975,213.
Insurance got denied, what to do next?
Those 428,806 denials are 14.6% of every in-network denial recorded in Ohio in this release, which makes Molina Healthcare of Ohio, Inc. the 3rd largest source of denials of the 10 insurers reporting there. Spread across its 22 plans in the state that is about 19,491 denials per plan. 216 internal appeals were filed against those 428,806 denials. Every one of those denials carried the same two dates the tool at the top of this page works out.
Two dates matter more than anything else on this page, and they run the same in Ohio as everywhere else. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
You are not alone, and here is the measured version of that sentence: 428,806 in-network claims were denied by Molina Healthcare of Ohio, Inc. in Ohio in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.
- Of the 10 insurers reporting a denial rate in Ohio, Molina Healthcare of Ohio, Inc. is the fourth highest at 21.7%. The highest in the state is 26.5% and the lowest is 8.3%.
- That is 3 percentage points above the 18.7% national average across this dataset, and 3.8 points above the Ohio average of 17.9%.
- Behind the percentage: 1,975,213 in-network claims were processed under 22 plans in Ohio, and 428,806 of them came back denied.
- For every 10,000 claims Molina Healthcare of Ohio, Inc. denied, about 5 came back as an internal appeal. The other 9,995 stopped at the letter.
- Of the internal appeals it did receive, Molina Healthcare of Ohio, Inc. overturned 50%, 108 claims that started life as a no.
- Its most-recorded denial reason is not medically necessary at 33.2% of its categorized denials, against 4.6% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- Molina Healthcare of Ohio, Inc. accounts for 14.6% of every in-network claim denied in Ohio in this file.
- By raw volume it is the 44th largest source of denials among the 158 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is administrative reason, 202,888 claims, 21% of its categorized denials.
- Third on its own list is referral required, 124,586 claims, 12.9% of what Molina Healthcare of Ohio, Inc. categorized in Ohio. Between them the top three account for 67.2% of its categorized denials.
- Where Molina Healthcare of Ohio, Inc. differs most from the national mix is not medically necessary: 33.2% of its categorized denials in Ohio against 4.6% across the file.
- Read the other way round: 1,546,407 of those 1,975,213 in-network claims were paid, 78.3% of everything Molina Healthcare of Ohio, Inc. processed in Ohio.
- Spread across the 22 plans it reports in Ohio, that is about 19,491 denied claims per plan, on about 89,782 claims processed per plan.
- Its reason columns add up to 964,133 categorized rows against 428,806 denials, 224.8% of them, and every reason share on this page is a share of that first figure rather than of the second.
- Its smallest recorded category in Ohio is experimental or investigational, 13,808 claims, 1.4% of what Molina Healthcare of Ohio, Inc. categorized there.
- Against the file as a whole, this one record is 0.5% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Molina Healthcare of Ohio, Inc. records most often in Ohio is not medically necessary, but yours may be one of the other 8, copy the exact wording and code off your own letter tonight, because that sentence is what your appeal has to answer.
- Ask Molina Healthcare of Ohio, Inc. in Ohio for the clinical criteria they judged you against. Under 29 CFR 2560.503-1 they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.
- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. Molina Healthcare of Ohio, Inc. overturned 50% of the internal appeals it did receive, 108 claims, so the stage you are about to start is not decorative.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| Molina Healthcare of Ohio, Inc. | 21.7% | , |
| Ohio average | 17.9% | +3.8 pts |
| National average (this dataset) | 18.7% | +3 pts |
Molina Healthcare of Ohio, Inc. denies 3 percentage points more of its in-network claims than the national average across this dataset. A denial rate is a property of the insurer's book of business, coding practice, plan design, the population it covers, not evidence about the merits of any one claim, including yours.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Molina Healthcare of Ohio, Inc.) | 216 | 50% |
| External review (independent) | not reported | not reported |
What that record means for your own Molina Healthcare of Ohio, Inc. letter, and by when. Molina Healthcare of Ohio, Inc. overturned 50% of the 216 internal appeals its Ohio members filed against 428,806 denials, and the Ohio escalation count for Molina Healthcare of Ohio, Inc. is the figure this page names as absent at the top, so how many of those denials went on to the independent stage is not something this page can tell you, Molina Healthcare of Ohio, Inc.'s own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 2026 (data.healthcare.gov). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal (29 CFR 2560.503-1(h)(3)(i), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Molina Healthcare of Ohio, Inc. notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for Molina Healthcare of Ohio, Inc. in Ohio. One payment. No subscription. No cut of your claim.
Molina Healthcare of Ohio, Inc. inside Ohio
Your denial did not happen in a national average. It happened in a state market, alongside 10 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Ohio, the 11 insurers reporting in this file processed 16,409,625 in-network claims and denied 2,934,307 of them, a state denial rate of 17.9%. Molina Healthcare of Ohio, Inc. is one of those 11.
- That puts Ohio 18th of 30 states by denial rate, 0.8 points below the 18.7% national average, before you get to what Molina Healthcare of Ohio, Inc. did inside it.
- Ohio recorded 35,236 internal appeals against those denials: one appeal for every 83 claims the state's insurers refused. Molina Healthcare of Ohio, Inc.'s own ratio is one for every 1,985.
- Independent external review was reached 954 times in the whole of Ohio, once for every 3,076 denials, against one in 14,369 nationally. How many came from Molina Healthcare of Ohio, Inc.'s denials is not on the record, that is the Ohio figure this page names as absent at the top and sources at the foot.
- Of the Ohio external reviews that were filed, 215 were overturned, 22.5%. That percentage is measured on 954 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Molina Healthcare of Ohio, Inc..
- The reason Ohio's insurers record most often is administrative reason, 951,084 claims, 26.4% of the state's categorized denials. Molina Healthcare of Ohio, Inc. records not medically necessary most often instead, which is the argument your letter will need to answer.
- The other insurers an Ohio reader could have bought from run from 26.5% (Oscar Buckeye State Insurance Corp.) to 8.3% (Community Insurance Company(Anthem BCBS)). Molina Healthcare of Ohio, Inc. at 21.7% sits between the two.
- Put the two together and Molina Healthcare of Ohio, Inc. is responsible for 14.6% of every in-network claim denied in Ohio in this release, from 12% of the claims the state's insurers processed.
- Every Ohio figure in this section is that state's own row in the same federal file Molina Healthcare of Ohio, Inc.'s numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full Ohio page is free at /states/ohio.
What Molina Healthcare of Ohio, Inc. denies most
The most common denial reason recorded for Molina Healthcare of Ohio, Inc. plans in Ohio is not medically necessary. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Not medically necessary | 320,315 | 33.2% | 4.6% |
| Administrative reason | 202,888 | 21% | 22.5% |
| Referral required | 124,586 | 12.9% | 8.4% |
| Benefit limit reached | 120,122 | 12.5% | 4.2% |
| Other reasons | 59,346 | 6.2% | 32.3% |
| Provider out of network | 57,686 | 6% | 9.8% |
| Member not covered | 51,215 | 5.3% | 6.6% |
| Service excluded from the plan | 14,167 | 1.5% | 11.6% |
| Experimental or investigational | 13,808 | 1.4% | 0.1% |
The last column is each reason's share of all categorized denials nationally, so you can see where Molina Healthcare of Ohio, Inc.'s mix in Ohio differs from everyone else's. This is denial mix, not overturn rate by reason, the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.
Put the date from your notice in and get the two calendar dates, with the days remaining.
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The three steps at the top of this page are the whole of what you have to do tonight. The longer version, what the internal appeal has to contain, how the independent stage works, and how to ask for expedited handling when waiting would seriously jeopardize your health, is published free here. For what it is worth on this page specifically: Molina Healthcare of Ohio, Inc. overturned 50% of the internal appeals it received.
Who appeals what at Molina Healthcare, the insurer's own routing table
Molina Healthcare publishes a table of which denial scenarios are appealed by you, the member ("customer appeal") and which only your health care provider can appeal. Almost no patient ever sees it, and appealing a denial that only your provider has standing to appeal burns time inside a fixed window. Quoted from Molina Healthcare's published policy (a page written for members (Iowa Medicaid plan)), checked 2026-08-25. It is brand-level and applies to Molina Healthcare of Ohio, Inc. in Ohio the same as to every other Molina Healthcare entity in the file.
| Denial scenario (Molina Healthcare's wording) | Who appeals it |
|---|---|
| Appeal of a denial (this Medicaid plan) | Your provider |
| Unhappy with Molina's appeal decision | Your provider |
Operational facts from the same policy
- Appeal filing window (this plan): 60 calendar days
- Decision clock: 30 calendar days standard, expedited available
- State Fair Hearing window: 120 calendar days
Source: Molina Healthcare, "Member Appeals & Grievances (Molina Healthcare of Iowa, Medicaid — hosted by Iowa HHS)", quoted, not paraphrased; audience: members (Iowa Medicaid plan); checked 2026-08-25. Brand-level policy, applied here because Molina Healthcare of Ohio, Inc. is a Molina Healthcare entity. Your own denial letter and plan documents govern your specific case.
Questions
Is Molina Healthcare of Ohio, Inc.'s denial rate in Ohio high?
21.7% against a national average of 18.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed a Molina Healthcare of Ohio, Inc. denial in Ohio, and how many won?
216 internal appeals were filed against 428,806 denials, and 50% of them were overturned (108 claims). How many went on to independent external review is not on the record for Molina Healthcare of Ohio, Inc. in Ohio, that is the absence stated at the top of this page and sourced at the foot of it.
How does Molina Healthcare of Ohio, Inc. compare with other insurers in Ohio?
Of the 10 insurers in Ohio with a reported denial rate, Molina Healthcare of Ohio, Inc. ranks 4 highest at 21.7%. The highest in Ohio is Oscar Buckeye State Insurance Corp. at 26.5%; the lowest is Community Insurance Company(Anthem BCBS) at 8.3%.
What does Molina Healthcare of Ohio, Inc. deny most often in Ohio?
Not medically necessary, 320,315 claims, 33.2% of this issuer's categorized denials, against 4.6% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal a Molina Healthcare of Ohio, Inc. denial in Ohio?
Generally 180 days from the date on the denial notice to file the internal appeal, then generally four months from the final internal denial to request independent external review. Expedited review, decided in about 72 hours, is available where delay would seriously jeopardize your health. Those timeframes are federal, so they are identical for every insurer reporting in Ohio, Molina Healthcare of Ohio, Inc. included, what varies by state is who runs the independent review at the end. Your own denial letter states the deadlines that govern your plan; that letter is the authority.
Does appealing a Molina Healthcare of Ohio, Inc. denial in Ohio cost anything?
The internal appeal to Molina Healthcare of Ohio, Inc. 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 per review. Nobody in Ohio can be charged more than that to file one.
Can Molina Healthcare of Ohio, Inc. ignore an external review decision in Ohio?
No, and that is the whole point of the stage. External review decisions are binding on the plan by law. The count is the one this page names as absent for Molina Healthcare of Ohio, Inc. in Ohio, so none is printed for it, an absent figure is not a count of none.
Molina Healthcare of Ohio, Inc. sits at 21.7% in Ohio against 18.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. I am not going to tell you that you will win. This page prints the insurer's own reported numbers whichever way they fall. If what it says does not match the letter in your hand, write to me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your Molina Healthcare of Ohio, Inc. appeal in Ohio: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
The Molina Healthcare of Ohio, Inc. figures on this page, the 21.7% denial rate, the 428,806 denials, are this issuer’s own reported rows in that file. CMS did not report an external-review figure for Molina Healthcare of Ohio, Inc. in Ohio in the plan-year 2026 release of the Transparency in Coverage file, which is why no external-review count appears above.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).