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State’s highest court to hear appeal of lawsuit against HMSA over treatment and coverage
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State’s highest court to hear appeal of lawsuit against HMSA over treatment and coverage

HONOLULU (HawaiiNewsNow) – The state Supreme Court has decided to accept a case involving a lawsuit against Hawaii’s largest health insurer.

The lawsuit against HMSA was filed by doctors and patients who claim care was denied because of the insurer’s pre-authorization process.

“She didn’t matter. It almost felt like it,” said Puna resident Craig McKinzie. He said his wife, Tammy Souza, told him HMSA refused to cover radiation treatment for her breast cancer.

Souza died in 2020, leaving McKinzie to care for their four children.

“The last thing he wrote was, ‘Before I die, I want everyone to know that HMSA was essentially responsible for my death,'” McKinzie said.

Scott Norton’s family also believe he would still be alive if HMSA had approved an MRI for back pain. They claim to have found the prostate cancer that took his life last November.

He had joined as a plaintiff in the suit before his death. His name is still listed in the lawsuit.

“We were very happy that it would go straight to the Supreme Court,” said Norton’s widow, Charlotte Husen. “This will not only save a lot of time for families who are waiting for some sort of resolution to what has really been a nightmare for many of us.”

Last February, Circuit Judge Robert Kim sided strongly with doctors and patients, declaring in a ruling: “The HMSA agreements unfairly infringe on the practice of medicine between the doctor and the patient.”

HMSA appealed the decision. In a statement, HMSA’s VP of Communications, Christine Hirasa, said: “HMSA understands that the procedural issues presented by this appeal could have been accepted by the Supreme Court to streamline the appeals process, and we look forward to resolving this limited procedural issue for this. case. As we have previously shared, this issue does not affect other agreements with HMSA suppliers or members.”

Frederick Nitta, the Hilo OB-GYN doctor leading the trial, disagrees that it’s just a single case.

“It’s not about me. I’m irrelevant,” he said. “What’s important is that patients get the care they need without the insurance carrier interfering and changing or preventing care.”

“If the court agrees with Dr. Nitta, it will reshape our health care in this state,” said plaintiffs’ attorney Ted Hong. He hopes the high court gives patients and doctors more power to negotiate what’s covered.

β€œIt could be substantial. It would be a game-changer for health care in our state.”