Adventist Health Castle Non-Par – FAQ

When will Adventist Health Castle hospital (Adventist) become a non-participating provider?

• Adventist Health Castle hospital (Adventist) will become a non-participating provider effective January 1, 2026, following the termination of our contract at the end of 2025, if we cannot come to an agreement by that date; we continue to work together to resolve this matter.

Which Adventist facilities are impacted?

• This affects Adventist Health Castle hospital.  

May I still access health services from Adventist and its affiliates?

Emergency Access and Coverage:

• For emergency services, there is no change—they are not impacted by these negotiations. You have access to Adventist facilities and UHA benefits provide coverage for emergency services.

Non-Emergency Health Services:

• For non-emergency health services that qualify as continuity of care—such as ongoing cancer treatment or an outpatient procedure the member pre-scheduled for 2026 during the time Adventist was still in the UHA network—Adventist is required to continue your care as if it is still participating in the UHA network and without any balance billing.
  
  
• For other non-emergency health services, UHA will assist in scheduling you to another hospital if you wish to avoid possible balance billing by Adventist. Please call UHA Health Care Services at: (808) 532-4006 or (800) 458-4600 toll-free.

Urgent Care:

• Adventist Health Castle Urgent Care clinics are not affected by these hospital negotiations and will remain in network. Before seeking care, it is good practice to check directly with the urgent care clinic to confirm its participation status in the UHA network.

Professional (Physician) Services:

• Professional services provided by physicians within Adventist facilities may be impacted depending on the individual physician’s contract arrangements with UHA. Please contact UHA or check with your physician to confirm the physician’s participation status in the UHA network.

UHA Health Insurance still has one of the largest physician networks in Hawai‘i and provides medical, drug and vision plans to over 57,000 members.

What happens if I access care from an Adventist facility starting January 1, 2026?

• Members who receive non-emergency health services at Adventist should be aware that Adventist may balance bill them for the amount beyond what UHA pays for member claims. UHA members have the option of seeing a provider outside of the participating UHA network, but this often means paying higher costs.
  • What is balance billing?
    When you see a provider that is not participating with UHA, you will owe any co-payment, coinsurance, deductible, and applicable taxes that apply to covered services plus potentially the difference between UHA’s payment for covered services and the provider’s actual charge. Also, non-participating providers have not agreed to UHA’s payment policies and can bill you for services or other charges that UHA does not cover.
    • For example:
      • Your insurance pays $100 for a service.
      • The provider charges $150.
      • You pay your normal copay or coinsurance plus the extra $50 the provider bills you in addition to applicable taxes and other charges the non-participating provider may bill you.
      • That extra amount is called balance billing.

 

• Therefore, UHA will make a temporary adjustment to reduce the impact on our members. For January 2026, UHA will temporarily pay these services at the participating provider benefit level. For example, under plan UHA 600, many services would be covered at 90% of the eligible charge instead of 70%.

Where can I find participating providers?

We are committed to our members and want to work to minimize any disruptions to you when seeking professional (physician) services. We are here to help you find alternative providers that meet your care needs.

• For non-emergency services, the UHA team is here to help members find other providers to minimize disruptions and avoid a balance billing situation. Please call UHA Health Care Services at: (808) 532-4006 or (800) 458-4600 toll-free.

• UHA members may view a list of alternative healthcare facilities by using our Provider Search Tool here: uhahealth.com/provider-search.

CONTINUITY OF CARE

I believe that by law, one of the UHA members in my household is entitled to continuity of care with a current healthcare provider. Where can I find out more about that?

• Members who qualify for continuity of care will be contacted by UHA directly. You can find out more by doing a search for “continuity of care” on UHA’s website at uhahealth.com. Again, we remain focused on our members’ care and minimizing any potential disruptions to them.

What about continuity of care for elective procedures?

• For non-emergency services that qualify as continuity of care—such as an outpatient procedure the member pre-scheduled for 2026 during the time Adventist was still in the UHA network—Adventist is required to continue your care as if it is still participating in the UHA network and without any balance billing.

Who do I contact at UHA if I have other questions about continuity of care?

• Please contact UHA Health Care Services:
  • On O‘ahu: (808) 532-4006
  • From the Neighbor Islands: 1(800) 458-4600 toll-free

BILLING

Should I pay a bill I receive directly from Adventist?

• Yes, please pay the bill directly. Adventist may still submit a claim to UHA on your behalf. If it does not, please mail or fax us the receipt so we may process your reimbursement for the eligible charges. UHA will continue to send direct payment to Adventist, and Adventist would then determine whether there is any additional balance that may be due to Adventist. This additional balance would be paid by the member directly to Adventist.

Will UHA cover the entire balance for services provided starting January 1, 2026?

• UHA will make a temporary adjustment to reduce the impact on our members. For January 2026, UHA will temporarily pay these services at the participating provider benefit level. For example, under plan UHA 600, many services would be covered at 90% of the eligible charge instead of 70%.

NEGOTIATIONS WITH ADVENTIST

What is the sticking point in the negotiations?

• We remain hopeful that we can come to an agreement with Adventist and negotiate a new contract. Because we respect the negotiation process and have been bargaining in good faith, it is not appropriate for us to disclose any details.

When will this be resolved so Adventist becomes fully participating again?

• To be clear, Adventist is a fully participating provider through December 31, 2025 at 11:59 p.m. HST.
   
  We do not yet have a clear timetable. We are continuing to actively negotiate and work towards a fair agreement with Adventist. At the same time, we are focused on keeping healthcare costs affordable for both employers and members.
   
  We are dedicated to supporting our members and minimizing any disruptions to them. As a local, physician-founded and guided health insurer and mutual benefit society, UHA will continue to work dutifully to manage your premium dollars so that you have access to affordable, high-quality care.

Is this only a problem with UHA? Is this happening with other insurers?

• We have no way of knowing whether other insurers are actively negotiating their contract with Adventist. 

Why won’t UHA cover the entire Adventist bills?

• We continue to actively negotiate with Adventist to reach an agreement to allow UHA to pay Adventist as a participating provider.  

• Even if Adventist is non-participating with us on January 1, 2026, UHA will make a temporary adjustment to reduce the impact on our members. For January 2026, UHA will temporarily pay these services at the participating provider benefit level. For example, under plan UHA 600, many services would be covered at 90% of the eligible charge instead of 70%.

COMMUNICATION/NOTIFICATION

I don’t remember getting any notice about this change. How did you communicate this to members?

Members, who received services at Adventist in 2025, were notified about this situation with an email update on December 30, 2025 followed by a USPS mailed letter sent out on December 31, 2025.

We also notified employers, who have affected employees, with an email update on December 30, 2025.

We have also posted a notice on our web site at: uhahealth.com/notices.