Hawaii Insurance Denial Report

The worst health insurers in Hawaii
by claim denial rate

Hawaii averages a 11.9% denial rate — 7.2 points below the national average. About 42,000 claims are denied annually.

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11.9%
Hawaii avg denial rate
19.1%
National average
42,000
Annual denials in state
>80%
Appeals overturned when filed

Health insurance denials in Hawaii

In Hawaii, the average health insurance claim denial rate stands at 11.9%, significantly lower than the national average of 19.1%. This means that while a smaller percentage of claims are denied in Hawaii, approximately 42,000 claims are still denied each year. This statistic reflects a human scale issue, impacting thousands of residents who may find themselves facing unexpected medical bills and the stress of navigating the appeals process. Understanding these denial rates is crucial for patients, as it highlights the importance of being informed and proactive in dealing with insurance claims.

Worst insurers in Hawaii by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

1

Kaiser Permanente

12.4% denial rate

Kaiser denies 12.4% of claims — 6.7 points below the national average. Their appeal overturn rate is 70%.

GLP-1 Medications: 19% deniedSpecialty Medications: 15% deniedMental Health: 12% denied
Full Kaiser denial report →
2

UnitedHealthcare

32.5% denial rate

UHC denies 32.5% of claims — 13.4 points above the national average. Their appeal overturn rate is 57%.

Specialty Medications: 43% deniedGLP-1 Medications: 41% deniedMRI / CT Scans: 35% denied
Full UHC denial report →

Your rights as a Hawaii insurance patient

Hawaii offers specific patient protections that empower individuals facing claim denials. Residents have the right to an internal appeal, allowing them to contest the decision directly with their insurance provider. Additionally, if the internal appeal is unsuccessful, patients can request an external Independent Medical Review through the Hawaii Insurance Division. This process is free and serves as a powerful tool for patients to pressure insurers to reconsider their claims, ensuring that they receive the care they deserve.

Hawaii Insurance Division
https://cca.hawaii.gov/ins

Start My Hawaii Appeal →

How to appeal a denial in Hawaii

  1. 1
    Request the denial in writing
    Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
  2. 2
    File your internal appeal
    Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Hawaii insurance law. A well-written appeal citing specific laws wins over 80% of the time.
  3. 3
    Escalate to the state if denied again
    If your internal appeal is denied, file an Independent Medical Review (IMR) with the Hawaii Insurance Division. This is free and decided by independent clinicians. Their decision is often binding.
  4. 4
    Use disputes.health to generate your letter
    Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.
How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

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