• Can a claim be reconsidered?
• What if I am still not satisfied with the final decision of my reconsidered claim?

 

Q. Can a claim be reconsidered?
A. If you would like a claim reconsidered for any reason, contact Member Services. We will attempt to resolve all concerns promptly.

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Q. What if I am still not satisfied with the final decision of my reconsidered claim?
A. If you are not satisfied with our response to your concern, you may file a formal appeal. The appeal must be filed within one year of the date UHA first informed you of the denial or limitation of the claim or coverage for any requested service. Customers may appoint someone to represent them during the appeal process, such as a guardian or legal representative. Appeals and representative appointments must be submitted in writing to:

UHA Appeals Coordinator
700 Bishop Street, Suite 300
Honolulu, HI 96813

Your appeal will be reviewed by staff not involved in the original decision. If the appeal concerns a clinical matter, it will be reviewed by an independent licensed practitioner with appropriate expertise and experience. If we need additional information to complete our review, we will notify you and give you reasonable time to respond.

For more information, please click here.

The final decision will be made by the UHA Appeals Committee. You will be notified of the final decision within 60 days of receipt of your written appeal, or within 30 days if your appeal concerns a denial of a prior authorization request.

Expedited Appeals
A member, a member's legal representative, or the member's treating provider can request an expedited appeal (72-hour response time for UHA’s final internal determination):
1. For an acute or urgent condition; or
2. If the standard time (60 days) for completing an appeal would
• seriously jeopardize the member's life or health
• seriously jeopardize the member's ability to gain maximum functioning; or
• in the opinion of a physician with knowledge of the appellant's medical condition, subject the member to severe pain that cannot be adequately managed without the care or treatment requested.

To request an expedited appeal, a member, member's representative, or member's treating provider, should contact Health Care Services. All necessary information regarding such urgent appeal may be submitted by telephone, fax, or other expeditious means. 

If the member is not satisfied with the final decision of the UHA Appeals Committee, the member has the right to bring a civil claim under ERISA, in accordance with your plan terms. 

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