Insurance

Please understand that none of the insurance companies guarantee payment on any service. Whenever they give out information, they first state the following disclaimer: The information being given is an estimate of coverage and not a guarantee of payment. Payment will be determined and confirmed based on patient eligibility at the time of service.

AARP, Aetna, Alohacare, BCBS, Cigna, DMBA, Devoted Health, Hawaii Laborers, HMA, HMAA, HMSA, HMSA Quest, Humana, Medicare, Medicaid, MDX, Ohana, PSWA, Quest, Tricare, TriWest, UHA, UHC, VA, Union Plans accepted. If your insurance is not listed here,please message us and we can contact them to find out about your coverage.

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PPO Plans – Generally means you can go to any doctor without a referral, BUT certain procedures may still require prior authorization from your insurance. Some plans require a consultation before testing.

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HMO – Requires referral from your primary care provider AND requires authorization from your insurance

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Medicare Medicaid-Quest- Generally allows you to go to any doctor without a referral, BUT may some Medicare and Medicaid plans may require prior authorization.

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Dual Coverage – This means that you have 2 insurance coverages and generally, since the state of Hawaii assesses tax on medical services, you only have to pay the tax on the service. Depending on your coverage, a referral and/or authorization may still be required.

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VA – Requires referral and authorization before being seen.

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Tricare Prime – Require referral and authorization before being seen.

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Tricare Select – Usually does not need referral but requires authorization for certain procedures.

Many insurance plans are 80%/20%, but this percentage varies with different plan types. The percentage indicates how much of the fee that the insurance pays and how much you are responsible for. So, an 80/20 percentage means that your insurance pays 80% of the eligible fee and your financial responsibility is 20% of the eligible fee. This is often called the Co-Pay or Co-insurance.

What does a deductible mean? It means that you must pay a certain amount before your benefits start. The deductible may apply to all services or only certain procedures. We can call your insurance to confirm.

When you have more than 1 insurance, the insurance law determines which one is primary (the one that must be billed first), secondary (the insurance that must be billed second) and tertiary (the insurance that is billed third). It is not something you can choose, it is determined by law and the primary insurance benefits dictate the coverage.

This means that your coverage does not cover treatment for certain diagnoses. For instance, if obesity is excluded on your plan – then any time a that diagnosis code for obesity is used on a claim, the insurance will not pay for it.

The state of Hawaii assesses tax on medical services, but most insurance companies do not cover the tax, so in Hawaii, you may be responsible for the tax on the service. Also, the tax is based on the eligible fee, not your copay or co-insurance. In general all Medicare, Medicaid and Federal plans are not taxed.