Hawaii Medical Service Association
reviews and complaints

i learned in december for my own need in communicating to hmsa: 1. call first thing in the morning as the day progresses you will be listening to automated message and music. during noon-time not all of the hmsa representatives are absent for lunch break. 2. am glad they mail correspondence to alert customers like me to take the next step for next year's coverage. all things need to be verified. 3. nice voices overall...!

I sent in a form for my mom's glasses that she got from a place that doesn't work with HMSA. They said we gotta talk to HMSA ourselves. I sent it in December but still haven't heard back even though I asked a bunch of times. They keep saying someone will call me soon but it's been almost 4 months and no one has called.

I'm having an issue with HMSA covering the cost of my routine check-up and blood tests that were taken care of by Hawaii Pacific Health. HMSA used to be my secondary coverage until 6 months ago, but they wouldn't cover my routine check-up since they thought they were secondary until I changed employers. The reason for filing a complaint is how slow HMSA takes when trying to resolve this issue. Bills are now coming in from the doctor's office, which is troubling. HMSA is not contacting HPH, and now I'm getting a bill for $650.

I retired and got two medical coverages - HMSA and Medicare. My spouse retired recently, so now Medicare is primary and HMSA is secondary. I planned my yearly "Well woman exam" with my ObGyn. But when she knew about my spouse's retirement, she refused to do the exam unless I got a letter from HMSA saying that they would cover it. She said Medicare only covers this type of visit every two years, and since Medicare is primary, they would deny the claim. She also said HMSA would deny it. I got a letter from HMSA saying they would cover it, and I sent it to my doctor, so she did the exam. As expected, Medicare denied the claim, and now HMSA is denying it too, even though they said they would pay. They lied, and now I'm in a tough spot with my doctor. She's a great doctor, but I'm worried she won't want to treat me anymore.

I had HMSA health insurance from January to June with a $5,000 out-of-pocket maximum. Then I switched to a plan with a $2,500 maximum. I called HMSA to confirm that payments made under the old plan would count towards the new one. They said yes. But when a provider submitted claims for services from January to May, HMSA didn't process them for two months. I called and the provider called, but we got the runaround. I had surgery in August, but because HMSA hadn't processed the claims, the $282.71 I paid in co-insurance didn't count towards my out-of-pocket maximum. I called HMSA many times to request that the claims be processed, but they didn't do it until September. After they processed the claims, my out-of-pocket maximum showed an overpayment of $282.71. I called HMSA to request a refund or payment to one of my surgery providers, but they said no. They claimed that because I had a $5,000 out-of-pocket maximum when I paid the $282.71, that's the maximum that applies. This is fraudulent. HMSA sat on the claims to force me to pay more. They should have processed the claims in the order of service date or when they received them. Instead, they committed fraud by processing them in a way that reduced what they had to pay.