If you disagree with HMSA’s appeal decision because the service requested did not meet payment determination criteria, did not meet medical policy requirements, or was determined to be investigative or experimental, you have the right to have your appeal reviewed by an Independent Review Organization.
- If you have a self-insured group plan, please call HMSA’s Member Advocacy and Appeals department at (808) 948-5090 or 1 (800) 462-2085 toll-free to request an external review.
- If you have a federal or other non-private plan, please follow the instructions provided in HMSA’s appeal decision letter. You may call HMSA if you have any questions about the information you received.
- If you have a fully insured group plan, please complete the following forms and submit them to the state insurance commissioner’s office. The insurance commissioner will contact you to make the necessary arrangements.
Please click on the link to access the form and form instructions:
Request for External Review by an Independent Review Organization
You can ask to have an independent review organization look over your appeal if you think we made a mistake.
HIPAA Authorization for Release of Information
The HIPAA Authorization for Release of Information form allows HMSA to share your information with certain people.
Disclosure for Conflicts of Interest Evaluation
This form asks you to name any conflicts of interest that may come up in your appeal process.