Posted on May 1, 2017 by Chapter Staff
Originally Published in HAPTA’s e-Newsletter, What’s HAPTAnin’ – May 2017

In response to a recent member query, past HAPTA President and “Chapter Historian” Herb Yee provided this authoritative and comprehensive recap about the state of direct access in Hawaii.

The issue of insurers continuing to require a physician referral is still prevalent in many if not most states, despite the passage of direct access in their areas. The topic is brought up in every reimbursement meeting nationally. In some areas this is changing – but slowly. Here’s the long version of what’s been happening with direct access in Hawaii.

In December of 2013, outgoing President Art Lum, Payment Chair Patti Taira-Tokuuke and I (as incoming president) met at HMSA with their PT liaison Ione and two of their physician advisers. We pointed out: 1) the legislation allowing PT treatment without a referral, 2) the potential cost saving to HMSA based on two studies at the time, 3) the growing physician shortage, 4) the fact that almost all referrals state “evaluate and treat” and 5) the de facto limit of number of visits imposed by Landmark. The physicians fully agreed with our points. About May of 2014 there was no decision made. When pressed, HMSA replied they decided to “keep the physician in the loop,” i.e., continue requiring a physician referral. We feel it was a decision “not to decide.” We have approached some of the other insurers and their general response has been that they’re waiting to see what HMSA does.

HAPTA’s Legislative Committee is planning on approaching HMSA again this year on this issue. We’ve no meeting scheduled yet. We’re waiting for the legislative session to wind down since we have a few irons in the fire there.

So in short, although the law allows for direct access in Hawaii, the insurers can set their own rules on requirements for reimbursement.