QUEST Integration – Transportation – Out-of-State

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

When unavailable locally, specialized services may be sought from the closest qualified provider. Pre-certification is required. HMSA will arrange air, lodging and meals if transportation is approved.

Services outside of the United States or in a foreign country are not covered for either children or adults.

Circumstances Considered Appropriate for Out-of-state Care

Bona fide emergencies while traveling out of state.

Non-emergency health care for members through the age of 18 years while traveling or visiting out of state.

Medically necessary services that are not available in Hawaii in a reasonable period of time.

Follow-up care for previously authorized out of state services by the same provider to ensure continuity of care.

Pre-certification Requirements

Requests must include the following:

• Patient’s member number.
• Full name and gender of the patient.
• The recommended treatment.
• Diagnosis.
• Period of out-of-state care.
• Justification for out-of-state care.
• Name and address of the out-of-state facility/provider.
• Name and telephone number of an authorized representative of the facility.
• Name of a non-medical attendant, if applicable; must travel with the patient in both directions.
• Any special travel accommodations (e.g., medical oxygen, service animals, etc.).

When making referrals due to non-availability of services, please ensure that a Hawaii specialist in the same field as the required service, or most closely related to that service, has evaluated the patient’s requirements and concluded that such service is not available in Hawaii. If you are that specialist, your assessment will suffice.

Consideration in choosing an out of state provider should include established expertise (e.g., Centers for Medicare and Medicaid Services and Blue Cross Blue Shield Association-certified centers of excellence), location, and BCBSA affiliation. Nonparticipating BCBSA providers will be considered only if a comparable participating provider is not available.

Travel Arrangements

The following services will be documented in the patient’s records and the requesting physician notified of the arrangements made by HMSA. We will also notify the patient of the arrangements.

Round-trip arrangements may be made if the patient is expected to return within 30 days.

One non-medical attendant (i.e., adult family member) will be authorized to accompany a child under 18 years. For adults, justification for an attendant based on factors such as impaired mobility or self-care must be provided. Attendants for companionship, as well as children to accompany an adult patient, are not sufficient grounds for an attendant for an adult. The need for emotional support will be considered only in extreme circumstances.

Related travel arrangements for lodging, meals and ground transportation for the patient and attendant, if applicable, will be arranged.

Transportation costs for the return of the patient and the attendant to the island of residence will be covered when discharged from an out-of-state facility, even if the patient was disenrolled from HMSA’s QUEST Integration plan during the out-of-state stay.

A meal allowance not to exceed $30 a day for adults and children over the age of 10 years is allowed for the number of days the member is not in the hospital and can eat orally. For children aged 3-10 years, the allowance is not to exceed $15 a day for food taken orally. For children under the age of 3 years who can eat orally, the allowance will be based on meal and grocery receipts, but no more than $15 a day.

Meal allowances will be made for up to the number of days of travel. Members may shop for groceries or food to eat in the hotel room for several days. Non-food items will not be reimbursed. Members may spend more or less than the indicated allowance, but the reimbursement will not exceed the allowance for the member and will be paid according to itemized receipts submitted for reimbursement. No reimbursement will be given without an itemized receipt.

To request reimbursement, the patient must submit an itemized invoice with receipts for purchased items to:

For dates prior to 7/1/25, please continue to submit to:

HMSA – QI Travel

P.O. Box 3520

Honolulu, HI  96811-3520

This article will be updated to provide instructions on how to submit reimbursement requests directly to Modivcare for dates starting on 7/1/25.

Revision History