Grievance and Appeals

• How AlohaCare or your provider runs their office
• Things AlohaCare or your provider does
• How AlohaCare or your provider behaved
• If AlohaCare denied your request to make a fast decision on your appeal and takes the standard amount of time to decide
• Issues with the quality of service or care
• If AlohaCare or your provider did not respect your rights
• If AlohaCare or your provider was rude
• If AlohaCare or your provider did not keep your information private

• Your name, address, phone number, AlohaCare member ID number and signature
• What you are unhappy about
• Copies of any papers that have to do with the problem
• Appointment of Representative: This form gives permission for a person to act on your behalf to file a grievance, appeal or coverage determination for you. 

Call or send your letter to:

• If AlohaCare denies or limits care that you or your doctor asks us to approve
• If AlohaCare reduces, delays or stops care we already approved
• If AlohaCare does not pay your doctor or other provider(s) for your care
• If AlohaCare does not get you care as quickly as you think we need to
• If AlohaCare delays getting you care you need
• If AlohaCare does not give you a timely answer to a grievance or an appeal you already filed
• If you live in a rural area or in an area with limited doctors, and AlohaCare does not agree to let you see a doctor not on our list

• Your name, address, phone number, AlohaCare member ID number and signature
• What you disagree with and why
• Copies of any papers that have to do with the appeal

If you are not happy with our response to your appeal, you can ask for a State fair hearing. You cannot ask for a State fair hearing if you did not send your appeal to AlohaCare first and received an answer from us. . You must write to the DHS Administrative Appeals Office within 120 days from the date of our decision.

You have the right to have representation at the hearing.  You can speak for yourself at the hearing.  Or, you can have a lawyer, friend, relative or someone else explain why you are not satisfied with the resolution of your appeal.

You can write a letter to:

 
State of Hawaii Department of Human Services
Attn: Administrative Appeals Office
P.O. Box 339
Honolulu, HI 96809

You can request an expedited State administrative hearing.  The State will respond within three business days of your request.

• Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.
• A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
• The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain AlohaCare’s files and records relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
• The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
• The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to AlohaCare’s Chief Executive Officer within 15 days of receiving the Section 1557 Coordinator's decision. The Chief Executive Officer shall issue a written decision in response to the appeal no later than 30 days after its filing.