You can ask us to reconsider a decision we made about services or benefits you’ve received or want to receive.
Print out the form and print clearly in all fields. Mail or fax the completed form to:
HMSA Member Advocacy & Appeals
P.O. Box 1958
Honolulu, HI 96805-1958
Fax: 808-952-7546 or 808-948-8206 on Oahu
You can also email your appeal to email@example.com, however, please note that unencrypted email could be intercepted. If you don’t want to take this risk, please fax or mail your appeal.
Standard appeal: After we receive your appeal request, we’ll respond within 30 days if it’s for a service you haven’t yet received. We’ll respond within 60 days if your appeal is for a service you’ve already received. Refer to your Evidence of Coverage for details about the standard appeal process.
Fast appeal: You can request a fast appeal if your health is in jeopardy. We’ll notify you by telephone and in writing of our decision within 72 hours. Refer to your Evidence of Coverage for details about the fast appeal process.