- A Care Coordinator helps you manage your medical providers and services. Your Care Coordinator is your main contact. This person helps you manage all of your providers, services and makes sure you get what you need. You and/or your caregiver may request a change in the Care Coordinator assigned, as needed, by calling the Care Coordinator or Member Services. Additionally, Molina Dual Options staff may make changes to your Care Coordinator assignment based upon your needs (cultural / linguistic / physical / behavioral health / religion) or location. Contact your Care Coordinator at (855) 735-5604 from 8:30 a.m. to 5 p.m., EST Monday - Friday.
- Your Care Team led by a Care Coordinator, is a group of advocates and providers working together to provide you with medical, behavioral health, substance use treatment, Long Term Services and Supports, and social needs. You have access to and input in the development of your own Integrated Care Team. You, your family member and/or your legally authorized representative are the most important members of the Integrated Care Team. You can tell us who else you would like to participate. Your Integrated Care Team may include:
- You
- Your family member and/or authorized representative.
- Your Care Coordinator
- Your Primary Care Provider (PCP)
- A representative from the facility where you receive care.
- Your behavioral health clinician (if you have one)
- Your long-term services and supports (LTSS) providers (if you have them) Your Integrated Care Team can also include the following people, if it is appropriate and if you agree:
- A pharmacist
- Nurses, specialists, social workers, and other people who can provide expert advice
- Family members
- Other informal caregivers
- Advocates
- State agency or other Care Coordinators
- Everyone on the Care Team works together to make sure your care is coordinated. This means that they make sure tests and labs are done once and the results are shared with the appropriate providers. It also means that your PCP should know all medicines you take so that he or she can reduce any negative effects. Your PCP will always get your permission before sharing your medical information with other providers.
Primary Care Provider (PCP)
You can get services from any provider who is in our network and accepting new members.First, you will need to choose a Primary Care Provider. A PCP is a physician, advanced practice nurse practitioner, physician assistant, and/or medical home/clinic (Federally Qualified Health Centers (FQHC) who gives you routine health care. You may also be able to have a specialist act as your PCP, when the specialist is willing to provide your routine healthcare. Please contact Member Services at (855) 735-5604, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., EST for assistance.
To choose a PCP, go to the list of providers on page based on your search results and choose a provider:
- that you use now, or
- who has been recommended by someone you trust, or
- whose offices are easy for you to get to.
- If you want help in choosing a PCP, please call Member Services at (855) 735-5604, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., EST. The call is free. Or, visit MolinaHealthcare.com/Duals.
- If you have questions about whether we will pay for any medical service or care that you want or need, call Member Services and ask before you get the service or care.
Long-term supports and services (LTSS)
As a Molina Dual Options member, you may be able to get long-term supports and services (LTSS), such as home health, personal care, nursing home and home and community based services (adult day program, respite, expanded community living supports, preventive nursing services, private duty nursing, and other services). LTSS helps people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.You should discuss long-term supports and services with your Care Coordinator to determine which services you qualify for and how to access them.
How to identify providers in Molina Dual Options network
You may need a referral to see someone who is not a Primary Care Provider. There is more information about referrals under the Key Terms section of this Provider and Pharmacy Directory Information.You must get all of your covered services from providers within our network. If you go to providers who are not in Molina Dual Options network (without prior authorization or approval from us), you will have to pay the bill.
“A prior authorization is an approval from Molina Dual Options before you can get a specific service, drug, or see an out-of-network provider. Molina Dual Options may not cover the service or drug if you don’t get approval.”
The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. Medicare and Medicaid do not provide coverage for emergency medical care outside the United States and its territories except under limited circ*mstances. Contact the plan for details. You can contact Molina Dual Options at (855) 735-5604, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., EST. You can also go outside the plan for other non-emergency services if Molina Dual Options gives you permission first.
- You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider. You can call Member Services at (855) 735-5604, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., EST if you want more information about our Molina Dual Options providers or if you need help with changing your PCP. For some providers, you may need a referral from your PCP.
- Molina Dual Options works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, search results of network providers in this Online Directory includes information about the accommodations they provide.
- If you need to see a provider and are not sure if they offer the accommodations you need, Molina Dual Options can help you. Talk to your Care Coordinator for assistance.
How to find Molina Dual Options providers in your area
To learn how to search for providers refer to the “Help” link located on the top portion of searchable online directory page.If you have questions about Molina Dual Options please call Member Services at (855) 735-5604, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., EST.
Network providers
This Online Directory of Molina Dual Options network providers contains:- Health care professionals including primary care providers, who may be physicians, physician assistants, or nurse practitioners; hearing, dental, or vision specialists
- Facilities including hospitals; urgent care centers; skilled nursing facilities/nursing facilities; Prepaid Inpatient Health Plan (PIHP) facilities for needs related to behavioral health, intellectual/developmental disability, and/or substance use
- Support providers including adult day programs; assistive technology; chore services; community transitions; environmental modifications; home-delivered meals; LTSS and non-LTSS home health agencies; medical supplies; non-medical transportation; personal care; preventive nursing; private duty nursing; respite care
“Cultural competence training is additional instruction for our health care providers that helps them better understand your background, values, and beliefs to adapt services to meet your social, cultural, and language needs.”
Network pharmacies
Molina Dual Options’ network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.You can also search pharmacies that are in our network but are outside our service area of: Macomb and Wayne in which you live. You may also fill your prescriptions at these pharmacies. Please contact Molina Dual Options at (855) 735-5604, TTY: 711, Monday – Friday, 8a.m. to 8 p.m. EST, for additional information.
- Molina Dual Options members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the Molina Dual Options Member Handbook for more information.
- Some network pharmacies may not be listed in this Online Directory.
- Some network pharmacies may have been added or removed from our plan after your search.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and Molina Dual Options List of Covered Drugs. The List of Covered Drugs can be found at
MolinaHealthcare.com/Duals.How to identify pharmacies in Molina Dual Options network
Along with retail and chain pharmacies, your plan’s network of pharmacies includes:- Mail-order pharmacies that send covered prescription drugs to members through the mail or shipping companies.
- Home infusion pharmacies that prepare prescription drugs given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
- Long-term care (LTC) pharmacies that serve residents of long-term care facilities, such as nursing homes.
- Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies.
Long-term supplies of prescriptions
- Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
- 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.
Mail order pharmacy
You can get prescription drugs shipped to your home through our network mail order delivery program which is called the CVS Caremark Mail Service Pharmacy Program. The pharmacy will contact you, by phone, to get your approval before shipping any prescriptions. If we are unable to reach you for approval, your prescription will not be sent to you.Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time or if you would like to cancel an automatic order, please contact us at (866) 830-2386. TTY: 711, 24 hours a day, 7 days a week. To learn more about mail order pharmacies, see Chapter 5 of the Member Handbook.
Home infusion pharmacies
You can get home infusion therapy if Molina Dual Options has approved your prescription and if you get your prescription from an authorized prescriber.Home Infusion Pharmacies service all counties in the Molina Dual Options service area. For more information on home infusion services and pharmacies, contact Member Services at (855) 735-5604, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., EST.
Long-term care pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Molina Dual Options through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, see Chapter 5 of the Member Handbook.Long-term Care Pharmacies services all counties in the Molina Dual Options service area. For more information on Long-Term Care services and pharmacies, contact Member Services at (855) 735-5604, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., EST.
Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) pharmacies
Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Molina Dual Options pharmacy network. Those other than Native Americans and Alaskan Natives may be able to go to these pharmacies under limited circ*mstances (e.g., emergencies).For more information, contact Member Services at (855) 735-5604, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., EST.
How to find Molina Dual Options pharmacy in your area
You can get your drugs covered at any of our network pharmacies. This includes our network pharmacies outside of our service area,To search for a pharmacy type within our network, go to
MolinaHealthcare.com/ProviderSearch and click on “Find a Pharmacy”. Then, select your state and coverage plan. A notification pop up will appear, letting you know the link will take you away from MolinaHealthcare.com/Duals. Click “OK” to be directed to the next page that will allow you complete your pharmacy search. Next, enter the ZIP code or city and state. You can further refine your search by specifying a pharmacy name and type. All pharmacies shown on the searchable online directory are available in our Network.If you have questions about any of the above, please contact Member Services or visit
MolinaHealthcare.com/Duals.H7844_21_17004_65_MIMMPPODInfo
