Referral Requirements
To schedule an appointment, all patients must have a referral from their Primary Care Provider (PCP).
The referral must include:
- Recent chart notes from your Primary Care Provider
- Recent laboratory results
- Chart notes and records from your current or previous rheumatologist and/or other treating specialists, if applicable
Please have your provider fax all required records to:
Fax: 866-397-2741
Appointments cannot be scheduled until all required records have been received and reviewed.
Please note: We do not accept self-referrals at this time. All new patients must be referred by their Primary Care Provider.
Insurance Plans Accepted
- Medicare
- UHA
- TriWest/Tricare
- HMSA PPO, HMO, and Akamai (out - of - network 01/01/2027)
- Humana PPO and HMO
- MultiPlan
- Self-Pay/Cash Patients
- UnitedHealthcare PPO (Out of Network)
- Kaiser PPO/Added Choice
Insurance Plans We Do Not Accept
- UnitedHealthcare Medicare Advantage
- UnitedHealthcare Community Plans
- UnitedHealthcare QUEST Integration
- MDX Hawaii
- HMAA
- Ohana Health Plan / Wellcare
- AlohaCare
Insurance Benefits & Prior Authorization
We recommend that all patients contact their insurance carrier directly to verify their benefits, coverage, deductible, copay, coinsurance, and referral requirements prior to their appointment.
If your insurance plan requires prior authorization for services, medications, or procedures, our office will obtain authorization when applicable.
Please note that authorization requirements and approval decisions are determined by your insurance company.
Out of Network? You May Still Have Options.
At Rheumatology Associates of Maui, we understand that your relationship with your physician matters. A change in insurance physician participation can feel unsettling, but it does not necessarily mean you have to change doctors.
Before making a decision, contact your insurance plan to understand your options:
What About My Medications, Labs, and Imaging?
An out-of-network office visit does not automatically mean every other part of your care will also be out of network.
Prescriptions filled through a participating pharmacy, laboratory testing performed at a participating lab, and imaging completed at a participating facility may still qualify for in-network coverage.
Your plan may have specific rules about orders from out-of-network physicians, referrals, and prior authorizations. Medications administered in our office and infusion services may also have different coverage requirements. Confirm these details with your insurer before receiving services.
Let’s Plan Your Next Steps Together
Call the member services number on your insurance card and ask for the following information for the year you will receive care, including 2027 if you are planning to continue with our office next year:
- Out-of-network coverage: Does your specific plan cover office visits with Rheumatology Associates of Maui?
- Deductible: What is your out-of-network deductible, and how much remains before your insurance begins paying?
- Copay and coinsurance: Is there a fixed copay, or what percentage of the cost will you be responsible for?
- Allowed amount: What amount does your plan use to calculate reimbursement for an out-of-network specialist visit? Will you be responsible for charges above that amount?
- Out-of-pocket maximum: Is there an out-of-network maximum, and which expenses count toward it?
- Network gap exceptions: Can you request an exception because of limited access to in-network rheumatology care on Maui? What documentation is required, and what would your costs be if approved?
- Continuity of care: Are you eligible to temporarily continue seeing your current physician at in-network rates? Ask about the application process, deadlines, and coverage period.
- Medications, labs, and imaging: Will services ordered by our physicians remain covered when provided through an in-network pharmacy, laboratory, or imaging facility? Are referrals or prior authorizations required? Ask separately about medications and infusions administered in our office.
- Claims and reimbursement: Will the plan reimburse our office directly, or will you need to pay and submit a claim yourself?
Your Health. Your Doctor. Your Voice.
- Out-of-network benefits: Does your plan cover visits with your current physician? Ask about your deductible, coinsurance, reimbursement, and any costs you may owe beyond the insurer’s allowed amount.
- Network gap exceptions: If there are limited in-network rheumatologists available on Maui, ask whether your plan will consider an exception allowing care with our practice at in-network benefit levels. Approval and payment terms must be confirmed.
- Continuity of care: If you are receiving ongoing treatment, ask whether you qualify for temporary continued care at in-network rates and how to apply.
Request your benefit details and any exception approvals in writing.
Record the representative’s name, the date of your call, and the call reference number.
Share this information with our office so we can help you understand our fees and provide an estimate for your planned care.
Final coverage and payment are determined by your insurance plan.
Benefits, exceptions, and continuity-of-care eligibility vary by plan. An estimate is not a guarantee of insurance payment.