Payment Determination Criteria
HMSA applies payment determination criteria to determine if a service or supply is covered by your plan.
Physical and Occupational Therapy Benefits
Physical therapy treats disease or injury using therapeutic exercises and other interventions to restore range of motion, improve posture and strength, and more.
How to Appeal an HMSA Decision
An appeal is a formal way of asking HMSA to review a decision on a denied claim. Learn more about the process.
Prior Approval for Medical Services (Precertification)
For some services, you or your physician must get approval from HMSA to make sure the services meet our payment guidelines.
Submitting a Precertification Request
Learn the steps you need to take to submit a precertification request by yourself or through a provider.
Screening and Diagnostic Tests
HMSA plans cover a variety of tests that can fall under one of two categories: screening or diagnostic. The reason you are taking a test determines the category.
Using Nonparticipating Providers for Physical or Occupational Therapy
If you’re currently seeing a provider outside Hawaii or a nonparticipating provider for therapy services, ask the provider to submit a precertification request for any services.
Services that are Reconstructive, Corrective, or Cosmetic
Reconstructive or corrective services are a benefit of your plan when they’re required to restore, reconstruct, or correct a bodily function that was lost, impaired, or damaged due to an illness or injury.
Services Your Plan Doesn’t Cover
Our benefits are designed to keep you safe, promote correct use of services, and keep health care costs down.
Physical and Occupational Therapy FAQs
HMSA covers short-term physical and occupational therapy that’s been diagnosed and ordered by a physician, physician’s assistant, or advanced practice registered nurse.