Molina Healthcare Denied Your Surgical Procedure?
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.
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 Surgical Procedure
Not medically necessary — conservative treatment recommended
Prior authorization not obtained or expired
Procedure classified as cosmetic or elective
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 Surgical Procedure Appeal
Surgeon letter of medical necessity with clinical justification
Documentation of failed conservative treatments
Peer-reviewed literature supporting the procedure
Pre-authorization documentation (if obtained but later denied)
Your rights
Laws That Protect You
ACA §2719 — Internal and external review rights
ERISA §502(a) — Right to sue for denied benefits
No Surprises Act — Emergency surgery protections
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
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Related denial guides
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Surgical Procedure denials by other insurers
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.