How to appeal a health insurance denial in Hawaii
The short answer
Start with your plan’s own appeal. If the plan says no again, you can usually ask an independent reviewer to decide. Hawaii lets you ask an independent reviewer to decide, through Hawaii Department of Commerce and Consumer Affairs, Insurance Division. The deadline to ask: within 130 days from the date of the coverage denial.
Does this apply to you? State external review covers plans regulated by Hawaii: individual and Marketplace plans, and job-based plans your employer bought from an insurer. Many large employers are self-funded; their plans follow the federal external review process, and state law usually does not apply (29 CFR 2590.715-2719(c)(1)). Medicare, Medicaid, TRICARE and federal employee plans have their own appeals: see the plan guides.
External review in Hawaii
Within 130 days from the date of the coverage denial
The independent review organization decides as fast as your condition requires, and no later than 72 hours after receiving an eligible expedited request. You can request expedited external review at the same time as an expedited internal appeal.
$15 filing fee payable to "Department of Commerce and Consumer Affairs". It is refunded if the denial is reversed, waived for undue financial hardship, and capped at $60 per plan year.
State-regulated plans (insurance bought in Hawaii or through an employer that buys insurance). Self-funded employer plans use the federal process.
Send the written request to the Insurance Commissioner (Insurance Division), not to the insurer. Include a copy of the plan's final internal determination, a signed medical-records release, a conflict-of-interest disclosure (your plan supplies the forms), and a cover letter explaining why the denial was wrong. Medicare, Medicaid, and self-funded plans where the insurer only administers claims are not eligible. The statute counts the 130 days from receipt of the notice of the adverse action.
Who to contact
Before external review: the internal appeal
External review usually comes after your plan’s own appeal. The deadline for that first appeal depends on the type of plan:
- Employer plan: 180 days from the day you receive the denial notice
- Marketplace plan: 180 days from the day you receive the denial notice
- Medicare Advantage: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Medicare Part D: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Original Medicare: 120 days from when you receive the notice (counted as 125 days from the notice date)
- Medicaid: 60 days from the date printed on the denial notice
- FEHB (federal employees): 6 months from the date of the denial notice
- TRICARE: Mail within 90 days after the date of the denial notice
Questions people ask
How long do I have to ask for an external review in Hawaii?
Within 130 days from the date of the coverage denial
Can I get a fast external review in Hawaii?
The independent review organization decides as fast as your condition requires, and no later than 72 hours after receiving an eligible expedited request. You can request expedited external review at the same time as an expedited internal appeal.
Does external review cost anything in Hawaii?
$15 filing fee payable to "Department of Commerce and Consumer Affairs". It is refunded if the denial is reversed, waived for undue financial hardship, and capped at $60 per plan year.
Do Hawaii’s rules apply to my job-based plan?
Only if the plan is fully insured, meaning your employer bought a policy from an insurance company. Self-funded employer plans generally follow the federal external review process instead. Your Summary Plan Description or HR benefits team can tell you which kind you have.
Sources
- Hawaii Insurance Division FAQs: External Review of Health Plan Disputes
From the date of the coverage denial, a member has 130 days to request an external review.
- HRS §432E-34 Standard external review
may file a request for an external review with the commissioner within one hundred thirty days of receipt of notice of an adverse action.
- HRS §432E-33 Request for external review
The annual aggregate limit on filing fees for any enrollee within a single plan year shall not exceed $60.
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.