If we make a coverage decision and you are not satisfied with our decision or part of our decision, you or your appointed representative can "appeal" the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. If your health requires a quick response, you may ask for a "fast appeal."
When you make an appeal, we review the coverage decision we have made to check to see if we were following all of the benefits properly. When we have completed the review we will give you our decision in writing.
If we say no to all or part of your initial appeal, there are additional levels of appeal outside our plan. If we deny your appeal, we will inform you about pursuing your appeal further. Also, these additional levels are explained in your Evidence of Coverage in Chapter 9 (“What to do if you have a problem or complaint (coverage decisions, appeals, complaints)”). To file an appeal or to ask process or status questions you or your representative may:
- Call 808-973-6395 or toll free at 1-866-973-6395
- TTY/TDD: 1-877-447-5990
- Fax: 1-800-830-7222
- Write: AlohaCare
Attn: Grievance & Appeals Division
1357 Kapi`olani Blvd, Suite G101
Honolulu, HI 96814
You can call us at our toll-free phone: 1-877-973-0712 and ask for an expedited appeal.
For an after-hours expedited appeals request you can call us at 808-356-5959.
If we decide that you do need an expedited appeal, we will make a decision and give you an answer within 72 hours. We will also call you with our decision and then will send you a letter with our decision in writing.
If we think that we need more information in order to do a more complete review, we will ask you if we can take more time (up to 14 days). We will let you know of any extension verbally and in writing. If you do not agree with the extension, we will make a decision within 72 hours using the information currently available.