Frequently Asked Questions

Refer to the diagram below. Please contact Customer Services if you need further assistance.

Yes, claims can be reconsidered for a variety of reasons. Please contact Customer Services for assistance.

If you are not satisfied with our response to your concern, and wish to pursue the matter further, you must appeal the decision by submitting a written appeal. The appeal must be filed within one year of the date UHA informed you of the denial or limitation of the claim or coverage for the requested service. Appeals 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 (nor a subordinate to the original decision maker). 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 view our Provider Handbook.

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 clinical matter.

Expedited Appeals
You may request an Expedited Appeal if the standard time (30 or 60 days, as set forth above) for completing an appeal would:

• seriously jeopardize the member’s life or health;
• seriously jeopardize the member’s ability to gain maximum functioning; or
• subject the member to severe pain that cannot be adequately managed without the care or treatment requested.

To request an Expedited Appeal, call Health Care Services.

If you wish to contest our decision on any appeal, you must agree to binding arbitration. To request binding arbitration, you must submit a written request for arbitration to UHA within 60 days of the date of the letter communicating the decision of the Appeals Committee. Both parties will agree on the person to serve as the independent arbitrator. The decision of the arbitrator is binding on both parties. Costs for the arbitration will be shared as ordered by the arbitrator. Further details are provided in your Participating Provider Agreement.