Molina Healthcare: surprise medical bill

Collect

• the bill
• EOB
• member ID card

Steps

1. Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.

2. Tell Molina (number on the ID card) and the provider that the bill may be a surprise bill.

3. Contact the CMS No Surprises Help Desk.

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

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

  8 citable points

  • Limit

    For emergency services, "you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate". This covers the hospital, the providers who treat you there, and air ambulance providers.

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

  • Policy

    The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.

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

  • Policy

    A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.

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

  • Deadline

    A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.

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

  • 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

  • Contact

    No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.

    Source: cms.gov, 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

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