How to Submit a Superbill to Molina Healthcare for Therapy Reimbursement

Molina Out-of-Network Process

Molina Healthcare primarily serves Medicaid and Marketplace members and generally does not cover OON mental health services. Molina operates as an HMO in most states, meaning members are expected to use in-network providers. In limited circumstances where OON care is approved due to lack of in-network availability, members must obtain prior authorization and submit claims through the Molina member portal or by mail.

Common Denial Reasons

• ✗No OON benefit exists under the member's Medicaid or standard Molina HMO plan
• ✗Prior authorization not obtained before OON service was rendered
• ✗Provider not licensed or registered in Molina's state of operation
• ✗Claim submitted without required referral from a Molina primary care provider

Tips for Getting Reimbursed by Molina

• ✓Molina clients typically cannot use OON superbill reimbursement — be transparent about this at intake
• ✓If a client's in-network wait time is excessive, Molina may grant an OON exception — clients should request this in writing
• ✓Some Molina Marketplace plans offer slightly more flexibility than Medicaid plans — always verify benefit type
• ✓Advise Molina clients to contact member services before their first session to explore all mental health access options