Molina Healthcare: billing error

Collect

• provider bill
• EOB
• member ID card

Steps

1. Compare the provider bill with the EOB.

2. Call the member services number on the ID card and ask for a correction. Ask the provider to rebill to the EOB amount.

3. If it is not fixed, file a grievance with the state plan.

More contacts for this issue

Facts you can cite

• Policy

  Molina's acquisition of ConnectiCare closed effective February 1, 2025. ConnectiCare had about 140,000 members in Marketplace, Medicare and certain commercial products.

  Source: investors.molinahealthcare.com, verified 2026-10-12

Rules in force

• No Surprises Act (surprise billing protections and good faith estimates)
  45 CFR part 149 (including 149.420 and 149.610)

  Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.

  Source: cms.gov, verified 2026-10-12

  3 citable points

  • Deadline

    Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.

    Source: law.cornell.edu, verified 2026-10-12

  • Deadline

    Patient-provider dispute resolution is available when the provider charged "$400 or more" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a "$25 non-refundable administrative fee".

    Source: cms.gov, verified 2026-10-12

  • Policy

    While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.

    Source: cms.gov, verified 2026-10-12

• Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements
  15 U.S.C. 8401-8405

  A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.

  Source: law.cornell.edu, verified 2026-10-12

  1 citable point

  • Policy

    The seller must obtain "a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account".

    Source: law.cornell.edu, verified 2026-10-12

If that fails, escalate

Go up one step at a time. Keep the reference numbers and dates from each contact.

1. Customer service

   PhoneMolina Marketplace member services, Florida +1-888-560-5716
   FormMedicaid appeals, Molina Michigan

   Call the member services number on the back of the member ID card. Molina numbers differ by state and by Medicaid, Medicare or Marketplace plan.

2. Written complaint

   FormComplaints and appeals, Molina Marketplace Washington

   Internal grievance or appeal with the state plan, at the address on the denial notice.

3. State agency

   Your state’s insurance department. Find it in the list of state agencies (also as JSON: states/<code>.json, for example states/ny.json).

   External review for Marketplace plans; Medicaid members can ask for a State Fair Hearing.

4. Federal regulator

   RegulatorU.S. Department of Labor, Employee Benefits Security Administration +1-866-444-3272

   Employer self-funded (ERISA) plans.

5. Federal regulator

   RegulatorCMS No Surprises Help Desk +1-800-985-3059

   Surprise bills under the No Surprises Act.

Watch out

Related

• Billing error at other companies
• Health insurance — how complaints work
• Molina Healthcare: insurance claim denied
• Molina Healthcare: surprise medical bill