An appeal is when you want us to reconsider a decision we’ve made about your health plan or prescription drug coverage for services or benefits you’ve received.
Standard appeal – Generally, we use the standard deadlines for giving you our decision. For an appeal for a medical service, a standard coverage decision means we will give you answer within 14 days after we receive your request. (We may take more time if we need information that could benefit you. If we take extra time, we'll tell you in writing.) For a standard appeal for prescription drugs, we'll give you answer within 7 calendar days.
Fast appeal – If your health requires it, you can ask for a fast appeal. We’ll give you an answer within 72 hours after we receive your appeal.
To start an appeal, you, your doctor, or your representative, must contact us. Print out and complete the appropriate appeal form and mail or fax it to our appeals coordinator at the address below.
Please print out and complete the appeal form and mail or fax it to our appeals coordinator at the address below.
To review your appeal, we’ll need the following information:
- Your full name.
- Your subscriber number.
- A daytime telephone number where we can reach you.
- The service (laboratory tests, surgery, prescription drug, etc.).
- Your HMSA notification of preauthorization denial.
- Provider name.
- Description of the facts, including why you think our decision is in error.
- Supporting documentation, if any.
- Personal Authorization, if applicable.
- Sign and date the form and mail it to:
HMSA Akamai Advantage
Attn: Appeals Coordinator
P.O. Box 1958
Honolulu, HI 96805-1958
Or fax to: 808-952-7546 or 808-948-8206 on Oahu
We’ll notify you of our decision regarding your appeal as quickly as your case requires, based on your health status, but no later than 30 calendar days after receiving your appeal for a future health plan service, 60 calendar days for a past service, or seven calendar days for a prescription drug. You can also request a fast appeal if your health is in jeopardy.
For process or status questions, members and/or physicians can contact HMSA Member Advocacy & Appeals at the numbers listed below.
During business hours: Monday through Friday, 8 a.m. to 6 p.m.: 808-948-5090 on Oahu or toll-free from the Neighbor Islands and Mainland at 1-800-462-2085. Calls to these numbers are free.
After business hours (Requests for fast appeals only): 808-948-6483. This is not a Customer Relations phone number. Calls to this number aren’t free.
TTY users call 711.