Who should I call if I have any questions about filing a complaint?

You can contact the Hawaii Division of Insurance at (808) 586-2790. The Division is open from 7:45 a.m. to 4:30 p.m. Monday through Friday.

What happens after the Division receives my complaint?

The Division will investigate your claim and attempt to resolve it with your health insurer. The Division can force your insurer to comply with your insurance policy, issue a citation, or fine the insurer for failure to comply. The Division...

How do I file a complaint?

If you are a Hawaii resident and your insurer denies your coverage after the external review process, you should speak with an investigator within the Division to determine if an informal resolution is possible. You can speak with an investigator...

How long will the external review process take?

The external review process should take no more than 45 days after receiving your request.[14] If you requested an expedited external review, the process should take no more than 72 hours after receiving your request.[15]

How do I request an external review?

You should submit your request for external review to the Hawaii Division of Insurance (“Division”) within 130 days from of your insurer’s last determination letter.[9] To request an external review, you should take the following steps: Request documents from your insurer. Ask...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[6] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Hawaii law, you are entitled to request an...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 60 days.[4] An expedited internal appeal should take no more than 72 hours after the request is submitted.[5]

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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