Health insurance or Medicaid said no in Hawaii? Deadlines and free help

In Hawaii, your health plan is regulated by Hawaii Department of Commerce and Consumer Affairs (DCCA), Insurance Division, Health Branch, if it is a state-regulated plan.

Hawaii runs its own independent review of denials: External Review (Insurance Commissioner). You generally have 130 days to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Med-QUEST

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Hawaii?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
130 days
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
90 days
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

The Insurance Division's Health Branch only handles private, fully insured health insurance issued in Hawaii. It does not handle Medicare, Medicaid (QUEST), TRICARE, the Federal Employees Health Benefits Program, employers, providers or workers' compensation. For questions about prepaid health care through an employer, contact the Department of Labor and Industrial Relations.

Step 1: Appeal to your plan in Hawaii

What it is called: Internal appeal with your health carrier

You must usually finish your health carrier's internal appeals before asking for external review. You can skip it if the carrier waives it, if the carrier substantially failed to follow its internal appeals process, or if you ask for an expedited external review at the same time as an expedited internal appeal.

Law: HRS 432E-33(b)

All the details →

Step 2: Outside review in Hawaii

External Review (Insurance Commissioner)

Deadline to ask: 130 days.

All the details →

Urgent care in Hawaii: faster decisions

Outside review

You can ask the Commissioner for an expedited external review if waiting would seriously jeopardize your life, health or ability to regain maximum function, or would leave you in severe pain that cannot be managed without the care; or if the denial concerns an admission, availability of care, a continued stay or emergency services and you have not been discharged. The reviewer decides as fast as your condition requires and no more than 72 hours after the request is found eligible.

Law: HRS 432E-33, 432E-34, 432E-35, 432E-36, 432E-37 (as amended by Act 103, SLH 2024, effective July 1, 2025)

Medicaid

If the normal hearing time would jeopardize your life or health or your ability to attain, maintain or regain maximum function, ask for an expedited hearing. The department decides within 3 working days whether to grant it; if granted, the hearing is decided no later than 3 working days after the department gets the request. Managed care members must first finish the health plan's expedited appeal.

Law: HAR 17-1703.1-4, 17-1703.1-5, 17-1703.1-11, 17-1703.1-16

Complaints about your plan in Hawaii

For other problems with a private, fully insured health plan, submit a complaint to the Insurance Division online or contact it at 808-586-2790 (Molokai/Lanai toll-free 800-468-4644), insurance@dcca.hawaii.gov, King Kalakaua Building, 335 Merchant Street, Room 213, Honolulu, HI 96813 (mail: P.O. Box 3614, Honolulu, HI 96811).

sbs.naic.org

Medicaid (Med-QUEST (Hawaii Medicaid, QUEST Integration managed care)) denials in Hawaii

Who holds the hearing: Hawaii Department of Human Services, Administrative Appeals Office (AAO).

Hearing deadline: 90 days

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Marketplace decisions in Hawaii

Hawaii uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Hawaii

Severe pain counts for urgent review

Hawaii lets you ask for an expedited external review not only when waiting would seriously jeopardize your life or health, but also when it would leave you in severe pain that cannot be adequately managed without the care that was denied.

Law: HRS 432E-35(a)

Medicaid: 15 days to keep benefits

For Med-QUEST eligibility actions, Hawaii gives 15 calendar days from the date of the notice to ask for a hearing and keep your benefits while you wait (10 days for a health plan's service denial).

Law: HAR 17-1703.1-5(b)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Hawaii and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Hawaii

Good to know in Hawaii

  • Hawaii gives 130 days from receiving the denial to ask for external review.

    Law: HRS 432E-34(a)

  • Hawaii charges a $15 external review filing fee, refunded if you win, waived for hardship, and capped at $60 per plan year.

    Law: HRS 432E-33(a)(4)

  • Act 103 of 2024 amended Hawaii's external review law to align with the NAIC model act, effective July 1, 2025 (DCCA 2025 External Review Report; HRS 432E-34 to 432E-36).

Changes in 2024–2026

Act 103, Session Laws of Hawaii 2024, amended HRS chapter 432E to be more consistent with the NAIC Uniform Health Carrier External Review Model Act, effective July 1, 2025 (DCCA Insurance Division, 2025 External Review Report to the Legislature).

Questions about appeals in Hawaii

How long do I have to appeal a health insurance denial in Hawaii?

Hawaii law does not set a different time to file. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Hawaii?

External Review (Insurance Commissioner). Send a written request to the Insurance Commissioner (DCCA Insurance Division, P.O. Box 3614, Honolulu, HI 96811; insurance@dcca.hawaii.gov; phone 808-586-2790). Include a copy of the carrier's final internal decision (unless you are allowed to skip the internal appeal), a signed authorization to release your medical records, a conflict-of-interest disclosure, and the $15 fee (or ask for a hardship waiver).

Is outside review free in Hawaii?

There is a $15 filing fee. It is refunded if the denial is reversed.

How long do I have to ask for a Medicaid fair hearing in Hawaii?

90 days. The date of the notice (Med-QUEST must RECEIVE the request within 90 calendar days; if day 90 is a weekend or holiday, the next working day)

Can I keep my Medicaid benefits while I appeal in Hawaii?

For eligibility or fee-for-service coverage actions, your Medicaid is reinstated and continued (Aid Paid Pending) if Med-QUEST receives your hearing request within 15 calendar days of the date of the notice. For a managed care health plan's denial, ask within 10 calendar days of the date of the plan's notice.

Who regulates health insurance in Hawaii?

Hawaii Department of Commerce and Consumer Affairs (DCCA), Insurance Division, Health Branch. The Insurance Division's Health Branch only handles private, fully insured health insurance issued in Hawaii. It does not handle Medicare, Medicaid (QUEST), TRICARE, the Federal Employees Health Benefits Program, employers, providers or workers' compensation.

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