MEDICAID is a government program that helps people pay for doctor visits and medical care if they have a low income.

Apply to MEDICAID Here.

Coverage means the health services that your insurance will pay for, like doctor visits, hospital stays, and medicine.

Eligibility is when you meet certain rules or requirements to get something, like health insurance or government help.

Ombudsman’s office

If you need assistance filing a grievance, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

An appeal is when you ask for a decision to be reviewed because you don’t agree with it, like when your insurance says it won’t cover something and you think it should.

If your Medicaid application has been denied, please contact the Med-QUEST Eligibility Branch Office at Med-QUEST Customer Service: 1-800-316-8005.  Additional contact information for your local Med-QUEST Eligibility Branch office is available Here.

Do you need help in another language? We will get you a free interpreter. Call 1-800-316-8005 to tell us which language you speak. (TTY: 1-800-603-1201 or 711).

¿Necesita ayuda en otro idioma? Nosotros le ayudaremos a conseguir un intérprete gratuito. Llame al 1-800-316-8005 y diganos que idioma habla. (TTY: 1-800-603-1201 o 711).

您需要其它語言嗎?如有需要, 請致電 1-800-316-8005, 我們會提供免費翻譯服務 (TTY: 1-800-603-1201 或 711).

En mi niit alilis lon pwal eu kapas? Sipwe angei emon chon chiaku ngonuk ese kamo. Kokori 1-800-316-8005 omw kopwe ureni kich meni kapas ka ani. (TTY: 1-800-603-1201 ika 711).

Avez-vous besoin d'aide dans une autre langue? Nous pouvons vous fournir gratuitement des services d'un interprète. Appelez le 1-800-316-8005 pour nous indiquer quelle langue vous parlez. (TTY: 1-800-603-1201 ou 711).

Brauchen Sie Hilfe in einer andereren Sprache? Wir koennen Ihnen gern einen kostenlosen Dolmetscher besorgen. Bitte rufen Sie uns an unter 1-800-316-8005 und sagen Sie uns Bescheid, welche Sprache Sie sprechen. (TTY: 1-800-603-1201 oder 711).

Makemake `oe i kokua i pili kekahi `olelo o na `aina `e? Makemake la maua i ki`i `oe mea unuhi manuahi. E kelepona 1-800-316-8005 `oe ia la kaua a e ha`ina `oe ia la maua mea `olelo o na `aina `e. (TTY: 1-800-603-1201 a 711).

Masapulyo kadi ti tulong iti sabali a pagsasao? Ikkandakayo iti libre nga paraipatarus. Awaganyo ti 1-800-316-8005 tapno ibagayo kadakami no ania ti pagsasao nga ar-aramatenyo. (TTY: 1-800-603-1201 wenno 711).

貴方は、他の言語に、助けを必要としていますか ? 私たちは、貴方のために、無料で 通訳を用意で きます。電話番号の、1-800-316-8005に、電話して、私たちに貴方の話されている言語を申し出てください。 (TTY: 1-800-603-1201 または 711).

다른언어로 도움이 필요하십니까? 저희가 무료로 통역을 제공합니다. 1-800-316-8005 로 전화해서 사용하는 언어를 알려주십시요 (TTY: 1-800-603-1201 1 또는 711).

您需要其它语言吗?如有需要,请致电 1-800-316-8005, 我们会提供免费翻译服务 (TTY: 1-800-603-1201 或 711).

Kwoj aikuij ke jiban kin juon bar kajin? Kim naj lewaj juon am dri ukok eo ejjelok wonen. Kirtok 1-800-316-8005 im kwalok non kim kajin ta eo kwo melele im kenono kake. (TTY: 1-800-603-1201 ak 711).

E te mana'o mia se fesosoani i se isi gagana? Matou te fesosoani e ave atu fua se faaliliu upu mo oe. Vili mai i le numera lea 1-800-316-8005 pea e mana'o mia se fesosoani mo se faaliliu upu. (TTY: 1-800-603-1201 po o le 711).

Kailangan ba ninyo ng tulong sa ibang lengguwahe? Ikukuha namin kayo ng libreng tagasalin. Tumawag sa 1-800-316-8005 para sabihin kung anong lengguwahe ang nais ninyong gamitin. (TTY: 1-800-603-1201 o 711).

'Oku ke fiema'u tokoni 'iha lea makehe? Te mau malava 'o 'oatu ha fakatonulea ta'etotongi. Telefoni ki he 1-800-316-8005 'o fakaha mai pe koe ha 'ae lea fakafonua 'oku ke ngaue'aki. (TTY: 1-800-603-1201 pe 711).

Bạn có cần giúp đỡ bằng ngôn ngữ khác không ? Chúng tôi se yêu cầu một người thông dịch viên miễn phí cho bạn. Gọi 1-800-316-8005 nói cho chúng tôi biết bạn dùng ngôn ngữ nào. (TTY: 1-800-603-1201 hoặc 711).

Gakinahanglan ka ba ug tabang sa imong pinulongan? Amo kang mahatagan ug libre nga maghuhubad. Tawag sa 1-800-316-8005 aron magpahibalo kung unsa ang imong sinulti-han. (TTY: 1-800-603-1201 o 711).

Exhausting grievance rights means you have used all the steps or ways you can to complain about something and have not received a solution. After exhausting these rights, you may not be able to take further action unless new options become available.

Exhausting appeal rights means you have gone through all the steps to ask for a decision to be changed or reviewed, and there are no more chances left to make the appeal. After exhausting your appeal rights, you can't take the issue further unless new options are offered.

For each health plan, CCS and HDS to submit a grievance or request an appeal can be accessed through the links listed below.

AlohaCare
 

HMSA
 

Kaiser Permanente

'Ohana Health Plan

‘Ohana Health Plan CCS

UnitedHealthcare Community Plan
 

Hawaii Dental Service (HDS)

A grievance resolution letter is a letter you get when your complaint or issue has been looked into and a decision has been made. It tells you what will be done to fix the problem or why no changes are being made.

See information in Health Plans.

A state grievance review is when a state government looks at a complaint or problem that wasn't solved. They check to see if the complaint was handled fairly and decide if something needs to be changed.

Learn how to File a State Grievance Review HERE.

Thank you for contacting Med-QUEST, you must have received the Final Resolution Letter in order to file an Appeal with the State. For further assistance please contact the STATE OMBUDSMAN office. The state Ombudsman’s office can help you work with your Health Plan.

A Notice of Adverse Benefit Determination is a letter or notice that tells you your health insurance or benefits claim has been denied or not approved. It explains why the decision was made and what you can do if you disagree with it.

See information in Health Plans.

A Final Resolution Letter is a letter that tells you the last decision about your complaint or problem. It explains how the issue was solved or why nothing more can be done.

See information in Health Plans.

See the Frequently Asked Questions (What are reasons to file an appeal? & How do I file an appeal with AAO?)

Continue to filing State Administrative Appeals Here.

Thank you for contacting Med-Quest, we look forward to supporting you. STAY WELL and STAY COVERED.

1. Contact Numbers for the Health Plans:

a. Aloha Care:(877) 973-0712

b. HMSA: (808) 692-8094

c. Kaiser Permanente: at 808-432-5330, toll free at 1- 800-651-2237, or 711 (TTY).

d. Ohana Health Plan: tel:1-888-846-4262

e. UnitedHealthcare: 1-888-980-8728

2. Contact Number for Dental Plan

a. HDS Medicaid: 1-855-819-9117 (TTY: 711) 7:30 AM to 4:30 PM, Monday through Friday.

3. Contact Number for Behavioral Health

a. Ohana Health Plan, CCS: tel:1-888-846-4262

4. The State Ombudsman office at 808-746-3324

5. 5. The Department of Human Services, Medicaid, Health Care Branch Services- Member Grievance Hotline at (808) 692-8094. Please note it can take up to 3 business day to receive a call back and call back are returned in order of date and time stamp.

 

FOR Frequently ASKED QUESTION

 

Thank you for contacting Med-QUEST, you must have received the Final Resolution Letter in order to file an Appeal with the State. For further assistance please contact the STATE OMBUDSMAN office. The state Ombudsman’s office can help you work with your Health Plan.

Applicant's Appeal Rights

If you do not agree with the foregoing determination, you may call, write, use other commonly available electronic means, or visit the Med-QUEST Eligibility Branch to request an informal review meeting with the eligibility worker and/or his/her supervisor. In addition, you may request an administrative hearing with a Hearing Officer. You will be given the opportunity to present evidence in support of your position that the intended action is incorrect.  You do not need to first have an informal review meeting in order to request an administrative hearing.

You must make your request for either an informal review or an administrative hearing in-person, by telephone, mail, or through other commonly available electronic means.  If you wish to submit a written request, you may use the Department’s form or write your request on any paper.  Your request must be received by our office within 90 calendar days from the date of this notice.

You may have someone else request, or speak, for you at the informal review or administrative hearing.  This person is called an authorized representative.  If you did not designate an authorized representative on your application, please provide written authorization for the person to represent you or you may use the Department’s Request for a Hearing form.  The written authorization must be received by the Med-QUEST Eligibility Office in order to acknowledge any actions taken by your authorized representative.  An authorized representative must agree to maintain, or be legally bound to the confidentiality of any information regarding the applicant or beneficiary that is provided by the department.  An authorized representative who is a provider, staff member or volunteer of an organization must agree to sign an agreement to comply with regulations relating to confidentiality of information, prohibition against reassignment of provider claims as appropriate for a health facility or an organization acting on the facility’s behalf; must meet the authentication and data security standards required under State and federal law or otherwise specified by the department.  If you choose to have an authorized representative, you may withdraw his or her name or replace the person with another authorized representative at any time.

At the informal review meeting or at the administrative hearing, you and/or your authorized representative will have the opportunity to explain why you do not agree with the decision.  At your request, our office will provide you with information about a Legal Aid Office that may be able to advise or represent you at no cost.  Please let us know if you need an interpreter or other aid to help you communicate with us at the informal review or administrative hearing.

H.A.R. 1703.1-2 & 1703.1-3

 

Contact Information:

Phone: *HOLDER*
Fax: *HOLDER*
Mailing Address:
*HOLDER*

Health Plans

AlohaCare QUEST (Medicaid) Members

Call: 808-973-0712

Toll-free: 1-877-973-0712

TTY/TDD: 1-877-447-5990

7:45 a.m. to 5 p.m.,

Monday through Friday


HMSA Quest Integration 

Member Advocacy and Appeals

PO Box 1958

Honolulu, Hi 96805-1958

TOLL FREE- 1-800-960-4672


FAX: 808-948-8224

Kaiser Permanente 

General information

808-432-0000

Member Services

1-800-966-5955 (toll free)

OHANA- Quest Integration 

1-888-846-4262

(TTY 711)

Monday- Friday 745 am to 4:30 pm HST

OHANA – Community Care Services (CCS) 

1-866-401-7540

(TTY 711)


24 hours, 7 days a week

UnitedHealthCare (UHC)

Quest Integration Program

1-888-980-8728 

TTY 711

Monday- Friday 7:45 am to 4:30 pm HST

HDS Hawaii Dental Services 

HDS Medicaid Customer Service 

Tel: (808) 529-9347

Toll Free (855) 819-9117

Fax (808) 529-9333

IF YOU HAVE MEDICAID AND ARE not satisfied with the quality of the care or service you received, the way the health plan staff, or doctor treated you,  or another matter, you file a grievance by contacting your health plan: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan. UnitedHealthcare Community Plan, Community Care Services (CCS) or Hawaii Dental Service (HDS).

 

What if I am not happy with my health plan’s grievance decision?

If you are not happy with your health plan’s decision, you can request a State Grievance Review

 

State Grievance Review

You may ask for a State Grievance Review from Med-QUEST/Department of Human Services, Health Care Services Branch.

In order to request a State Grievance Review, you must complete the following steps:

1.      You have filed a grievance with the Health Plan, CCS or HDS. (See FAQ #6)

2.      You have received a Grievance Resolution Letter. If you do not have a Grievance Resolution Letter, contact your health plan, CCS or HDS.

 

You may request a State Grievance Review within 30 days of the date of your Grievance Resolution Letter.

To request a State Grievance Review, call 808-692-8094, leave a message, speak slowly and clearly provide the following information:

1.      Your full name

2.      Your last name

3.      Your phone number

4.      The reason for your call

5.      The date of your resolution letter

 

Med-QUEST will return your call within 3 business days.

The outcome or resolution of the State Grievance Review is final.

 

Authorized Representatives (See FAQ #17 - #19)

If you need assistance filing a grievance, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

IF YOU HAVE MEDICAID AND ARE DENIED A BENEFIT, DENIED PAYMENT OR COVERAGE FOR A SERVICE, OR YOUR SERVICES ARE REDUCED, you can appeal this decision by contacting your health plan: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan. UnitedHealthcare Community Plan, Community Care Services (CCS) or Hawaii Dental Service (HDS).

 

What if I am not happy with my health plan’s Appeal decision?

If you are not happy with your health plan’s decision, you can request an Appeal  (You can request a State level appeal)

 

State Administrative Appeal

To request a State Administrative Appeal, you must complete the following steps:

1.      You have filed an appeal with the Health Plan.

2.      You have received a Resolution of Appeal Letter from your health plan. If you do not have a Resolution of Appeal Letter, contact your health plan.

 

You may request a State Administrative Appeal within 120 days of the date of your Resolution of Appeal Letter.

Your request for a State Administrative Appeal can be sent in writing, email to:

 

In writing:

State of Hawaii Department of Human Services,

Administrative Appeals Office,

PO Box 339

Honolulu, HI 96809-0039

 

Email:

[email protected]

 

In person or by calling:

Your local Med-QUEST office.

If you need assistance filing an appeal, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

 

Authorized Representatives  (See FAQ #17 - #19)

 

If you need assistance filing an appeal, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

 

Frequently Asked Questions

Applicants, members, and/or their authorized representatives can file a grievance when they have a complaint about anything that does not involve appealing a decision, such as a denial or discontinuance of services or benefits.

Examples

  • General Complaints
  • Environmental hazard conditions at a doctor's office (dirt or clutter, unsanitary practices, overcrowded waiting areas)
  • Impoliteness or rudeness of providers (doctors, doctor's office staff, hospital personnel, etc.)
  • Impoliteness or rudeness of office staff (eligibility offices, AHCCCS Offices, Department of Economic Security Offices, Department of Health Services Offices, etc.)

An appeal is a request from an applicant, member, provider, health plan, or other approved entity to reconsider or change a decision, also known as an action.

An action includes any denial, reduction, suspension, or termination of a service or benefit, or a failure to act in a timely manner.

Examples

  • Denial of request for surgery
  • Denial of a request for a wheelchair
  • Denial of basic health care services
  • Denial or discontinuance of AHCCCS eligibility

Member is an individual who has been approved for Medicaid and has been assigned a Health Plan.

Some reasons for submitting a grievance include:

1.      The quality of the care or service you received.

2.      The way the health plan staff treated you.

3.      How you were treated by the doctor or staff.

4.      The exercise of your members rights related to your healthcare.

The time to make a prior authorization decision.

In order to request a State Grievance Review, you must complete the following steps:

1.      You have filed a grievance with the Health Plan, CCS or HDS.

2.      You have received a Grievance Resolution Letter. If you do not have a Grievance Resolution Letter, contact your health plan, CCS or HDS.

You may request a State Grievance Review within 30 days of the date of your Grievance Resolution Letter.

To request a State Grievance Review, call 808-692-8094, leave a message, speak slowly and clearly provide the following information:

1.      Your full name

2.      Your last name

3.      Your phone number

4.      The reason for your call

5.      The date of your resolution letter

Med-QUEST will return your call within 3 business days. The outcome or resolution of the State Grievance Review is final.

a)       When a Member receives a Notice of Adverse Benefit Determination, the Member first requests for an appeal with the Health Plan.

b)      After a decision is made regarding the appeal, the Health Plan will send a Final Resolution letter to the Member to inform them of the appeal decision.

c)     The Member will then be able to request for a State administrative hearing.

a)       If the Member is not satisfied with the written notice of the final disposition of the appeal from the Health Plan, the Member may file for a State administrative hearing within one hundred and twenty (120) days.

b)     If the Member is not satisfied with the decision by the hearing officer, the Member may file for an appeal with the Court.

If you need assistance filing a grievance or appeal, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

 

If you are interested in applying for Medicaid, please click this link:

https://medquest.hawaii.gov/en/members-applicants/get-started/how-to-apply.html

Med-QUEST Eligibility Branch Office at Med-QUEST Customer Service:

1-800-316-8005 toll-free. TTY users, call 1-855-889-4325 toll-free or 711.

Additional contact information for your local Med-QUEST Eligibility Branch office is available at: Contact Us

a.       AlohaCare

b.      HMSA

c.       Kaiser Permanente

d.      Ohana Health Plan

e.       UnitedHealth Community Plan

Yes, if they are designated to be Member’s Authorized Representative

A representative can be a relative, friend, advocate, attorney, doctor (other than your treating physician), or someone else to act on member’s behalf.

a)     Member can allow another person to represent their interest during any stage of a Grievance or Appeal process.

b)    Member can request to appoint an Authorized Representative, in person or by telephone in which member gives a written authorization. DHS 1121

Medicaid ask that if you have been appointed or given legal authority to represent member, then you may submit a completed DHS 1121A form, including attaching a copy of the appropriate legal document.


Do you need help in another language? We will get you a free interpreter. Call 1-800-316-8005 to tell us which language you speak. (TTY: 1-800-603-1201 or 711).

¿Necesita ayuda en otro idioma? Nosotros le ayudaremos a conseguir un intérprete gratuito. Llame al 1-800-316-8005 y diganos que idioma habla. (TTY: 1-800-603-1201 o 711).

您需要其它語言嗎?如有需要, 請致電 1-800-316-8005, 我們會提供免費翻譯服務 (TTY: 1-800-603-1201 或 711).

En mi niit alilis lon pwal eu kapas? Sipwe angei emon chon chiaku ngonuk ese kamo. Kokori 1-800-316-8005 omw kopwe ureni kich meni kapas ka ani. (TTY: 1-800-603-1201 ika 711).

Avez-vous besoin d'aide dans une autre langue? Nous pouvons vous fournir gratuitement des services d'un interprète. Appelez le 1-800-316-8005 pour nous indiquer quelle langue vous parlez. (TTY: 1-800-603-1201 ou 711).

Brauchen Sie Hilfe in einer andereren Sprache? Wir koennen Ihnen gern einen kostenlosen Dolmetscher besorgen. Bitte rufen Sie uns an unter 1-800-316-8005 und sagen Sie uns Bescheid, welche Sprache Sie sprechen. (TTY: 1-800-603-1201 oder 711).

Makemake `oe i kokua i pili kekahi `olelo o na `aina `e? Makemake la maua i ki`i `oe mea unuhi manuahi. E kelepona 1-800-316-8005 `oe ia la kaua a e ha`ina `oe ia la maua mea `olelo o na `aina `e. (TTY: 1-800-603-1201 a 711).

Masapulyo kadi ti tulong iti sabali a pagsasao? Ikkandakayo iti libre nga paraipatarus. Awaganyo ti 1-800-316-8005 tapno ibagayo kadakami no ania ti pagsasao nga ar-aramatenyo. (TTY: 1-800-603-1201 wenno 711).

貴方は、他の言語に、助けを必要としていますか ? 私たちは、貴方のために、無料で 通訳を用意で きます。電話番号の、1-800-316-8005に、電話して、私たちに貴方の話されている言語を申し出てください。 (TTY: 1-800-603-1201 または 711).

다른언어로 도움이 필요하십니까? 저희가 무료로 통역을 제공합니다. 1-800-316-8005 로 전화해서 사용하는 언어를 알려주십시요 (TTY: 1-800-603-1201 1 또는 711).

您需要其它语言吗?如有需要,请致电 1-800-316-8005, 我们会提供免费翻译服务 (TTY: 1-800-603-1201 或 711).

Kwoj aikuij ke jiban kin juon bar kajin? Kim naj lewaj juon am dri ukok eo ejjelok wonen. Kirtok 1-800-316-8005 im kwalok non kim kajin ta eo kwo melele im kenono kake. (TTY: 1-800-603-1201 ak 711).

E te mana'o mia se fesosoani i se isi gagana? Matou te fesosoani e ave atu fua se faaliliu upu mo oe. Vili mai i le numera lea 1-800-316-8005 pea e mana'o mia se fesosoani mo se faaliliu upu. (TTY: 1-800-603-1201 po o le 711).

Kailangan ba ninyo ng tulong sa ibang lengguwahe? Ikukuha namin kayo ng libreng tagasalin. Tumawag sa 1-800-316-8005 para sabihin kung anong lengguwahe ang nais ninyong gamitin. (TTY: 1-800-603-1201 o 711).

'Oku ke fiema'u tokoni 'iha lea makehe? Te mau malava 'o 'oatu ha fakatonulea ta'etotongi. Telefoni ki he 1-800-316-8005 'o fakaha mai pe koe ha 'ae lea fakafonua 'oku ke ngaue'aki. (TTY: 1-800-603-1201 pe 711).

Bạn có cần giúp đỡ bằng ngôn ngữ khác không ? Chúng tôi se yêu cầu một người thông dịch viên miễn phí cho bạn. Gọi 1-800-316-8005 nói cho chúng tôi biết bạn dùng ngôn ngữ nào. (TTY: 1-800-603-1201 hoặc 711).

Gakinahanglan ka ba ug tabang sa imong pinulongan? Amo kang mahatagan ug libre nga maghuhubad. Tawag sa 1-800-316-8005 aron magpahibalo kung unsa ang imong sinulti-han. (TTY: 1-800-603-1201 o 711).

MEDICAID is a government program that helps people pay for doctor visits and medical care if they have a low income.

Apply to MEDICAID Here.

Coverage means the health services that your insurance will pay for, like doctor visits, hospital stays, and medicine.

Eligibility is when you meet certain rules or requirements to get something, like health insurance or government help.

Ombudsman’s office

If you need assistance filing a grievance, please call the Medicaid Ombudsman’s Office: KOAN at 808-746-3324

An appeal is when you ask for a decision to be reviewed because you don’t agree with it, like when your insurance says it won’t cover something and you think it should.

If your Medicaid application has been denied, please contact the Med-QUEST Eligibility Branch Office at Med-QUEST Customer Service: 1-800-316-8005.  Additional contact information for your local Med-QUEST Eligibility Branch office is available Here.

Do you need help in another language? We will get you a free interpreter. Call 1-800-316-8005 to tell us which language you speak. (TTY: 1-800-603-1201 or 711).

¿Necesita ayuda en otro idioma? Nosotros le ayudaremos a conseguir un intérprete gratuito. Llame al 1-800-316-8005 y diganos que idioma habla. (TTY: 1-800-603-1201 o 711).

您需要其它語言嗎?如有需要, 請致電 1-800-316-8005, 我們會提供免費翻譯服務 (TTY: 1-800-603-1201 或 711).

En mi niit alilis lon pwal eu kapas? Sipwe angei emon chon chiaku ngonuk ese kamo. Kokori 1-800-316-8005 omw kopwe ureni kich meni kapas ka ani. (TTY: 1-800-603-1201 ika 711).

Avez-vous besoin d'aide dans une autre langue? Nous pouvons vous fournir gratuitement des services d'un interprète. Appelez le 1-800-316-8005 pour nous indiquer quelle langue vous parlez. (TTY: 1-800-603-1201 ou 711).

Brauchen Sie Hilfe in einer andereren Sprache? Wir koennen Ihnen gern einen kostenlosen Dolmetscher besorgen. Bitte rufen Sie uns an unter 1-800-316-8005 und sagen Sie uns Bescheid, welche Sprache Sie sprechen. (TTY: 1-800-603-1201 oder 711).

Makemake `oe i kokua i pili kekahi `olelo o na `aina `e? Makemake la maua i ki`i `oe mea unuhi manuahi. E kelepona 1-800-316-8005 `oe ia la kaua a e ha`ina `oe ia la maua mea `olelo o na `aina `e. (TTY: 1-800-603-1201 a 711).

Masapulyo kadi ti tulong iti sabali a pagsasao? Ikkandakayo iti libre nga paraipatarus. Awaganyo ti 1-800-316-8005 tapno ibagayo kadakami no ania ti pagsasao nga ar-aramatenyo. (TTY: 1-800-603-1201 wenno 711).

貴方は、他の言語に、助けを必要としていますか ? 私たちは、貴方のために、無料で 通訳を用意で きます。電話番号の、1-800-316-8005に、電話して、私たちに貴方の話されている言語を申し出てください。 (TTY: 1-800-603-1201 または 711).

다른언어로 도움이 필요하십니까? 저희가 무료로 통역을 제공합니다. 1-800-316-8005 로 전화해서 사용하는 언어를 알려주십시요 (TTY: 1-800-603-1201 1 또는 711).

您需要其它语言吗?如有需要,请致电 1-800-316-8005, 我们会提供免费翻译服务 (TTY: 1-800-603-1201 或 711).

Kwoj aikuij ke jiban kin juon bar kajin? Kim naj lewaj juon am dri ukok eo ejjelok wonen. Kirtok 1-800-316-8005 im kwalok non kim kajin ta eo kwo melele im kenono kake. (TTY: 1-800-603-1201 ak 711).

E te mana'o mia se fesosoani i se isi gagana? Matou te fesosoani e ave atu fua se faaliliu upu mo oe. Vili mai i le numera lea 1-800-316-8005 pea e mana'o mia se fesosoani mo se faaliliu upu. (TTY: 1-800-603-1201 po o le 711).

Kailangan ba ninyo ng tulong sa ibang lengguwahe? Ikukuha namin kayo ng libreng tagasalin. Tumawag sa 1-800-316-8005 para sabihin kung anong lengguwahe ang nais ninyong gamitin. (TTY: 1-800-603-1201 o 711).

'Oku ke fiema'u tokoni 'iha lea makehe? Te mau malava 'o 'oatu ha fakatonulea ta'etotongi. Telefoni ki he 1-800-316-8005 'o fakaha mai pe koe ha 'ae lea fakafonua 'oku ke ngaue'aki. (TTY: 1-800-603-1201 pe 711).

Bạn có cần giúp đỡ bằng ngôn ngữ khác không ? Chúng tôi se yêu cầu một người thông dịch viên miễn phí cho bạn. Gọi 1-800-316-8005 nói cho chúng tôi biết bạn dùng ngôn ngữ nào. (TTY: 1-800-603-1201 hoặc 711).

Gakinahanglan ka ba ug tabang sa imong pinulongan? Amo kang mahatagan ug libre nga maghuhubad. Tawag sa 1-800-316-8005 aron magpahibalo kung unsa ang imong sinulti-han. (TTY: 1-800-603-1201 o 711).

Exhausting grievance rights means you have used all the steps or ways you can to complain about something and have not received a solution. After exhausting these rights, you may not be able to take further action unless new options become available.

Exhausting appeal rights means you have gone through all the steps to ask for a decision to be changed or reviewed, and there are no more chances left to make the appeal. After exhausting your appeal rights, you can't take the issue further unless new options are offered.

For each health plan, CCS and HDS to submit a grievance or request an appeal can be accessed through the links listed below.

AlohaCare
 

HMSA
 

Kaiser Permanente

'Ohana Health Plan

‘Ohana Health Plan CCS

UnitedHealthcare Community Plan
 

Hawaii Dental Service (HDS)

A grievance resolution letter is a letter you get when your complaint or issue has been looked into and a decision has been made. It tells you what will be done to fix the problem or why no changes are being made.

See information in Health Plans.

A state grievance review is when a state government looks at a complaint or problem that wasn't solved. They check to see if the complaint was handled fairly and decide if something needs to be changed.

Learn how to File a State Grievance Review HERE.

Thank you for contacting Med-QUEST, you must have received the Final Resolution Letter in order to file an Appeal with the State. For further assistance please contact the STATE OMBUDSMAN office. The state Ombudsman’s office can help you work with your Health Plan.

A Notice of Adverse Benefit Determination is a letter or notice that tells you your health insurance or benefits claim has been denied or not approved. It explains why the decision was made and what you can do if you disagree with it.

See information in Health Plans.

A Final Resolution Letter is a letter that tells you the last decision about your complaint or problem. It explains how the issue was solved or why nothing more can be done.

See information in Health Plans.

See the Frequently Asked Questions (What are reasons to file an appeal? & How do I file an appeal with AAO?)

Continue to filing State Administrative Appeals Here.

Thank you for contacting Med-Quest, we look forward to supporting you. STAY WELL and STAY COVERED.

1. Contact Numbers for the Health Plans:

a. Aloha Care:(877) 973-0712

b. HMSA: (808) 692-8094

c. Kaiser Permanente: at 808-432-5330, toll free at 1- 800-651-2237, or 711 (TTY).

d. Ohana Health Plan: tel:1-888-846-4262

e. UnitedHealthcare: 1-888-980-8728

2. Contact Number for Dental Plan

a. HDS Medicaid: 1-855-819-9117 (TTY: 711) 7:30 AM to 4:30 PM, Monday through Friday.

3. Contact Number for Behavioral Health

a. Ohana Health Plan, CCS: tel:1-888-846-4262

4. The State Ombudsman office at 808-746-3324

5. 5. The Department of Human Services, Medicaid, Health Care Branch Services- Member Grievance Hotline at (808) 692-8094. Please note it can take up to 3 business day to receive a call back and call back are returned in order of date and time stamp.

 

FOR Frequently ASKED QUESTION

 

Thank you for contacting Med-QUEST, you must have received the Final Resolution Letter in order to file an Appeal with the State. For further assistance please contact the STATE OMBUDSMAN office. The state Ombudsman’s office can help you work with your Health Plan.

Click here if you require medical benenfit assistance.

If your Medicaid application has been denied, please contact the Med-QUEST Eligibility Branch Office at Med-QUEST Customer Service: 1-800-316-8005

Do you need help in another language? We will get you a free interpreter. Call 1-800-316-8005 to tell us which language you speak. (TTY: 1-800-603-1201 or 711).

¿Necesita ayuda en otro idioma? Nosotros le ayudaremos a conseguir un intérprete gratuito. Llame al 1-800-316-8005 y diganos que idioma habla. (TTY: 1-800-603-1201 o 711).

您需要其它語言嗎?如有需要, 請致電 1-800-316-8005, 我們會提供免費翻譯服務 (TTY: 1-800-603-1201 或 711).

En mi niit alilis lon pwal eu kapas? Sipwe angei emon chon chiaku ngonuk ese kamo. Kokori 1-800-316-8005 omw kopwe ureni kich meni kapas ka ani. (TTY: 1-800-603-1201 ika 711).

Avez-vous besoin d'aide dans une autre langue? Nous pouvons vous fournir gratuitement des services d'un interprète. Appelez le 1-800-316-8005 pour nous indiquer quelle langue vous parlez. (TTY: 1-800-603-1201 ou 711).

Brauchen Sie Hilfe in einer andereren Sprache? Wir koennen Ihnen gern einen kostenlosen Dolmetscher besorgen. Bitte rufen Sie uns an unter 1-800-316-8005 und sagen Sie uns Bescheid, welche Sprache Sie sprechen. (TTY: 1-800-603-1201 oder 711).

Makemake `oe i kokua i pili kekahi `olelo o na `aina `e? Makemake la maua i ki`i `oe mea unuhi manuahi. E kelepona 1-800-316-8005 `oe ia la kaua a e ha`ina `oe ia la maua mea `olelo o na `aina `e. (TTY: 1-800-603-1201 a 711).

Masapulyo kadi ti tulong iti sabali a pagsasao? Ikkandakayo iti libre nga paraipatarus. Awaganyo ti 1-800-316-8005 tapno ibagayo kadakami no ania ti pagsasao nga ar-aramatenyo. (TTY: 1-800-603-1201 wenno 711).

貴方は、他の言語に、助けを必要としていますか ? 私たちは、貴方のために、無料で 通訳を用意で きます。電話番号の、1-800-316-8005に、電話して、私たちに貴方の話されている言語を申し出てください。 (TTY: 1-800-603-1201 または 711).

다른언어로 도움이 필요하십니까? 저희가 무료로 통역을 제공합니다. 1-800-316-8005 로 전화해서 사용하는 언어를 알려주십시요 (TTY: 1-800-603-1201 1 또는 711).

您需要其它语言吗?如有需要,请致电 1-800-316-8005, 我们会提供免费翻译服务 (TTY: 1-800-603-1201 或 711).

Kwoj aikuij ke jiban kin juon bar kajin? Kim naj lewaj juon am dri ukok eo ejjelok wonen. Kirtok 1-800-316-8005 im kwalok non kim kajin ta eo kwo melele im kenono kake. (TTY: 1-800-603-1201 ak 711).

E te mana'o mia se fesosoani i se isi gagana? Matou te fesosoani e ave atu fua se faaliliu upu mo oe. Vili mai i le numera lea 1-800-316-8005 pea e mana'o mia se fesosoani mo se faaliliu upu. (TTY: 1-800-603-1201 po o le 711).

Kailangan ba ninyo ng tulong sa ibang lengguwahe? Ikukuha namin kayo ng libreng tagasalin. Tumawag sa 1-800-316-8005 para sabihin kung anong lengguwahe ang nais ninyong gamitin. (TTY: 1-800-603-1201 o 711).

'Oku ke fiema'u tokoni 'iha lea makehe? Te mau malava 'o 'oatu ha fakatonulea ta'etotongi. Telefoni ki he 1-800-316-8005 'o fakaha mai pe koe ha 'ae lea fakafonua 'oku ke ngaue'aki. (TTY: 1-800-603-1201 pe 711).

Bạn có cần giúp đỡ bằng ngôn ngữ khác không ? Chúng tôi se yêu cầu một người thông dịch viên miễn phí cho bạn. Gọi 1-800-316-8005 nói cho chúng tôi biết bạn dùng ngôn ngữ nào. (TTY: 1-800-603-1201 hoặc 711).

Gakinahanglan ka ba ug tabang sa imong pinulongan? Amo kang mahatagan ug libre nga maghuhubad. Tawag sa 1-800-316-8005 aron magpahibalo kung unsa ang imong sinulti-han. (TTY: 1-800-603-1201 o 711).

For each health plan, CCS and HDS to submit a grievance or request an appeal can be accessed through the links listed below.

AlohaCare
 

HMSA
 

Kaiser Permanente

'Ohana Health Plan
 

‘Ohana Health Plan CCS
 

UnitedHealthcare Community Plan
 

Hawaii Dental Service (HDS)

Hyper link to the health PLANS

Hyperlink to Grievance section

Hyperlink to the health Plan

Thank you for contacting Med-QUEST. For further assistance please contact the STATE OMBUDSMAN office. (Hyperlink OMBUDSMAN) The state Ombudsman’s office can help you work with your Health Plan.

hyperlink: show what a Final Resolution letter  looks like

hyperlink to Health Plan

Hyperlink to Appeals

Hyperlink to the Health Plan

Thank you for contacting Med-QUEST, you must have received the Final Resolution Letter in order to file an Appeal with the State. For further assistance please contact the STATE OMBUDSMAN office. (Hyperlink OMBUDSMAN) The state Ombudsman’s office can help you work with your Health Plan.

Thank you for contacting Med-Quest, we look forward to supporting you. STAY WELL and STAY COVERED.

1. Contact Numbers for the Health Plans:

a. Aloha Care:

b. HMSA: (808) 692-8094

c. Kaiser Permanente: at 808-432-5330, toll free at 1- 800-651-2237, or 711 (TTY).

d. Ohana Health Plan: tel:1-888-846-4262

e. UnitedHealthcare: 1-888-980-8728

2. Contact Number for Dental Plan

a. HDS Medicaid: 1-855-819-9117 (TTY: 711) 7:30 AM to 4:30 PM, Monday through Friday.

3. Contact Number for Behavioral Health

a. Ohana Health Plan, CCS: tel:1-888-846-4262

4. The State Ombudsman office at 808-746-3324

5. The Department of Human Services, Medicaid, Health Care Branch Services- Grievance Hotline at (808) 692-8094. Please note it can take up to 3 business day to receive a call back and call back are returned in order of date and time stamp.

 

FOR Frequently ASKED QUESTION