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Imaging Denial

Molina Healthcare Denied Your CT Scan?

Published data shows denial and appeal outcomes vary by plan, product year, denial reason, and documentation. Use this page to spot the issues to request and the evidence to gather before you decide what to submit.Sources include KFF ACA Marketplace Transparency Data, HHS OIG reports, and state insurance department filings. Aggregate rates are context, not predictions for an individual case.

Varies
Denial Data
Case-specific
Appeal Outcome
30-45 days
Typical Timeline
$1,000–$5,000
Typical Claim

Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.

Why they said no

Why Molina Healthcare Denies CT Scan

Not medically necessary based on clinical criteria

MRI recommended instead of CT

Prior imaging not attempted first

Molina Healthcare patterns

Molina Healthcare's Common Denial Patterns

Denying specialist referrals as not medically necessary

Applying Medicaid criteria to marketplace plans

Delays in prior authorization processing

What works

How to Strengthen Your CT Scan Appeal

Physician order with clinical indication

Evidence that CT is more appropriate than MRI for the condition

ACR Appropriateness Criteria supporting CT for diagnosis

Your rights

Laws That Protect You

ACA — Preventive screening requirements

State imaging parity laws

Emergency prudent layperson standard

Playbook

Tips for Appealing to Molina Healthcare

Molina serves many Medicaid/marketplace enrollees — cite state Medicaid rules if applicable

File a complaint with your state Medicaid agency for Medicaid-managed care plans

Request expedited review if treatment is urgent

Ready to Review Your CT Scan Denial?

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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.