Molina Healthcare Denied Your MRI Scan?
According to federal data, Molina Healthcare Inc. denies approximately 21% of claims. When patients appeal, about 42% are overturned. Your mri scan denial may have grounds for a successful appeal.Sources: KFF ACA Marketplace Transparency Data, HHS OIG Reports, state insurance department filings. Rates are aggregate averages — individual results vary by plan type, denial reason, and documentation.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
Why Molina Healthcare Denies MRI Scan
Prior authorization required but not obtained
Deemed not medically necessary at this stage
Lower-cost imaging (X-ray, CT) not tried first
Molina Healthcare's Common Denial Tactics
Denying specialist referrals as not medically necessary
Applying Medicaid criteria to marketplace plans
Delays in prior authorization processing
How to Win Your MRI Scan Appeal
Clinical notes explaining why MRI is specifically needed over other imaging
Documentation of symptoms warranting urgent imaging
Peer-to-peer review between ordering physician and insurer medical director
Laws That Protect You
ACA §2719 — Right to appeal imaging denials
No Surprises Act — Protection against balance billing
State laws requiring timely authorization decisions
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 MRI 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.