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  • Molina Healthcare Changeinformation

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Requested Effective date of change: Authorizing signature: (Physician/Office Manager signature required; email signature okay) Today s Date: / / Group Name: Email Address Phone Number Authorizing name printed: P.

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Some of the benefits that are offered to you as a Molina Dual Options Cal MediConnect member are doctor visits, inpatient hospital care*, skilled nursing facilities*, wellness visits, mammograms, and much more - all with $0 copay!

Oral Surgery Medical treatments related to oral conditions such as infections, TMJ, cleft palate, and post-accident surgeries, are covered by Molina Healthcare. Oral surgery for cosmetic purposes is not covered. Prior authorization required.

Massage Therapy Not covered. Maternity Care Covered. Mental Health Covered through Community Mental Health Centers (CMHCs).

Molina Health PlansMedicaid Molina Healthcare contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP).

Covered benefit Selected diagnostic services (including CT scans, MRIs, MRAs, PET Scans, and SPECT) require PA. Durable Medical Equipment (DME) Covered benefit Some durable medical equipment items require PA. Covered benefit PA is not required.

Limited to 25 visits per year. Members under 21 can get additional visits if authorized. Physical therapy and speech therapy visits in the home health setting are not covered through the home health program for beneficiaries age 21 and over. All Medicaid policy restrictions apply.

Braces (Orthodontics) Covered for children under the age of 20 and subject to medical review and limitations. If prior authorized and started by another provider, services related to the braces are covered through the end of the period initially authorized for the braces. Prior authorization required.

Molina Healthcare Inc. Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232