Hawaii Medical Service Association claim denials in Hawaii: the federal figures
Hawaii Medical Service Association denied 23.2% of in-network claims in Hawaii — 147,935 claims out of 637,079. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Hawaii Medical Service Association) | 61 | 45.9% |
| External review (independent) | — | — |
What Hawaii Medical Service Association denies most
The most common denial reason recorded for Hawaii Medical Service Association plans in Hawaii is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 104,227 | 58.9% |
| Service excluded from the plan | 26,584 | 15% |
| Administrative reason | 20,743 | 11.7% |
| Benefit limit reached | 19,106 | 10.8% |
| Member not covered | 3,164 | 1.8% |
| Referral required | 2,166 | 1.2% |
| Not medically necessary | 978 | 0.6% |
| Experimental or investigational | 128 | 0.1% |
What to do if Hawaii Medical Service Association denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Hawaii Medical Service Association overturned 45.9% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Hawaii Medical Service Association. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Hawaii Medical Service Association appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Hawaii Medical Service Association's denial rate high?
23.2% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Hawaii Medical Service Association ignore the external decision?
No. External review decisions are binding on the plan.