Medicare Member Appeals

An appeal is when you want us to reconsider a decision we’ve made about your health plan or prescription drug coverage for services or benefits that have been requested or received.

Standard appeal – Generally, we use the standard deadlines for giving you our decision. For an appeal for a medical service you haven’t yet received, we will give you an answer within 30 days after we receive your request. (We may take more time if we need information that could benefit you. If we take extra time, we'll tell you in writing.) For a standard appeal for prescription drugs, we'll give you an answer within 7 calendar days.

Fast appeal – If your health requires it, you can ask for a fast appeal. We’ll give you an answer within 72 hours after we receive your appeal.

Instructions

To start an appeal, you, your doctor, or your representative, must contact us. You may use the following appeal forms to mail or fax to our appeals coordinator at the address below.

To review your appeal, we’ll need the following information:

  • Your full name.
  • Your subscriber number.
  • A daytime telephone number where we can reach you.
  • The service (laboratory tests, surgery, prescription drug, etc.).
  • Your HMSA notice of coverage or denial.
  • Provider name.
  • Description of the facts, including why you think our decision is in error.
  • Supporting documentation, if any.
  • Personal Authorization, if applicable.
  • Sign and date the form and mail it to:

HMSA Akamai Advantage
Attn: Appeals Coordinator
P.O. Box 1958
Honolulu, HI 96805-1958

Or fax to: 808-952-7546 or 808-948-8206 on Oahu

For process or status questions, members and/or physicians can contact HMSA Member Advocacy & Appeals at the numbers listed below.

During business hours: Monday through Friday, 8 a.m. to 8 p.m.: 808-948-5090 on Oahu or toll-free from the Neighbor Islands and Mainland at 1-800-462-2085. Calls to these numbers are free.

After business hours (Requests for fast appeals only): 808-948-6483. This is not a Customer Relations phone number. Calls to this number aren’t free.

TTY users call 711.