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 by calling (808) 586-2790 between the hours of 7:45 a.m. and 4:30 p.m., Monday through Friday.[16]

If an informal resolution is not possible, you can file a complaint with the Insurance Division.

Complaint information. You can find a copy of the complaint form here. Your complaint should include the following information:

  • The name, age, address, email address, and telephone number of the person filing the complaint (“Complainant”);
  • The name of the insured individual, if different from the Complainant;
  • The names of any other parties involved in the claim (for example, the plan administrator);
  • The name of insurance company and the type of insurance;
  • The policy number, certificate number, claim number, date of loss or service, and reason for the complaint;
  • What you consider to be a fair resolution.[17]

Supporting documents. You should submit the following documents as supporting information:

  • A copy of your insurance card;
  • Copies of coverage denials or adverse benefit determinations from your insurer;
  • Copies of any determinations made by internal and external reviewers;
  • Any materials submitted with prior appeals and complaints;
  • Supporting documentation from your health care provider;
  • A copy of your insurance policy; and
  • All responses from your insurer. [18]

How to submit. You can submit the complaint and supporting documents by fax to (808) 587-5379 or by mail to:

Hawaii Insurance Division
Health Insurance Branch
P.O. Box 3614
Honolulu, HI 96811[19]