Grievance and Appeals

The following information explains the grievance, coverage determination, organization determination, and appeals processes for AlohaCare Advantage Plus (HMO SNP).

A coverage decision is the initial decision we make about your benefits and coverage or about the amount we will pay for your medical services or drugs. We are making a coverage decision anytime we decide what is covered for you and how much we will pay. If you are having problems getting medical care, a service you requested, or payment (including the amount you have already paid) for medical care or services you have already received, then you can resolve the problem through a coverage decision. If your health requires a quick response, you should ask us to make a "fast decision." If we say no, you have the right to ask us to reconsider - and perhaps change - this
  • Request for Medicare Prescription Drug Coverage Determination: request a drug that is not covered by our formulary.
  • Medicare Redetermination Request Form: let us know if you disagree with a Medicare drug determination decision we made.
     
    To request a Coverage Decision or to ask process or status questions you, your doctor, or your representative may:
  • Call 973-6395 or toll free at 1-866-973-6395
  • TTY/TDD: 1-877-447-5990
  • Fax: 1-800-830-7222
  • Write: AlohaCare 
    Attn: Grievance Coordinator
    1357 Kapiolani Blvd, Suite 1250
    Honolulu, HI 96814
 
H5969_400620_18 Pending