]When a person finally enters substance use disorder treatment, it usually comes after a long period of fear, chaos, and uncertainty. Families have often exhausted themselves emotionally and financially before their loved one ever arrives at a treatment center. By the time treatment begins, everyone is hoping for the same thing: stability.

Too often, Hawaiʻi’s insurance payment system does the opposite.

In many cases, even when a patient signs an Assignment of Benefits directing payment to the treatment provider, reimbursement is still sent to the patient instead of the provider. In some cases, those checks can be very large. In the substance use disorder treatment setting, that is not just a billing issue. It can become a patient safety issue.

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This is not a theoretical concern. There are real stories in Hawaiʻi of people who have relapsed, overdosed, and died after large reimbursement checks were sent directly to them in early recovery.
Imagine someone who has just completed treatment and is trying to stay sober. They are in early recovery, one of the most vulnerable periods in the healing process. Then a check for tens of thousands of dollars arrives in the mail.

At the same time, the provider that delivered the care may still be unpaid. The family is confused. The patient is suddenly caught in the middle of a financial and administrative mess they are not equipped to manage.

This is not how a recovery-supportive system should work. No one in early recovery should be turned into the middleman between the insurer and the treatment provider.

In Hawaiʻi, HMSA has become central to this problem. At the very moment a family is trying to help a loved one stay sober, the reimbursement is sent to the patient, the provider is left unpaid, and everyone is pulled into confusion and conflict. HMSA has already shown it can pay providers directly in mainland cases. Here in Hawaiʻi, too often, it still does not.

A person leaving treatment is supposed to be focused on recovery, stability, and reconnecting with life. Instead, they can end up holding a very large check at one of the most fragile moments in sobriety. Families who already stretched to get a loved one into care are left confused and financially exposed.

The provider that delivered the care may still be unpaid. And when basic claim information is hard to get, the patient is forced into the middle of disputes that should never land on their shoulders in the first place.

For many Hawaiʻi families, this means coming up with enormous sums of money upfront and hoping reimbursement comes later. Many cannot do that. Some delay treatment. Some never start. Some look to the mainland, where direct-payment protections are more established, and end up sending a loved one away from their ʻohana at exactly the moment family support matters most.

This is particularly troubling in Hawaiʻi, where treatment options are already limited and families often have fewer alternatives. We should be removing barriers to care, not building more of them into the insurance process.

Some will say this is just an administrative payment dispute. It is not. Payment routing affects whether treatment providers can sustainably serve local families. It affects whether families can get their loved ones into care in the first place. And it affects whether a person leaving treatment is given a real chance at stability or is pulled back into financial chaos and risk.

This is also not a radical idea. According to a 2019 50-state summary published by AHIP, 29 states had already enacted laws or regulations requiring health insurance plans or HMOs to accept assignments of benefits or make direct payments to non-participating providers. Hawaiʻi has not yet adopted comparable protections.

There is a reason this issue is now in front of lawmakers. What may look like paperwork on the back end of treatment can have life-altering consequences on the front end of recovery. Senate Bill 2425 is intended to change that.

Families should not have to fear that after doing everything they can to get a loved one into treatment, the insurance process will undermine recovery on the back end.

This is not a theoretical concern.

Patients should not be put in the position of receiving large reimbursement checks while trying to rebuild their lives.

Providers should not be forced to explain to families that care was delivered, but the reimbursement was sent somewhere else.

And Hawaiʻi should not accept a payment system that ignores the realities of early recovery.
When treatment has been provided and the patient has signed paperwork directing payment to the treatment provider, the reimbursement should go where it belongs. That approach is safer, cleaner, and far more consistent with the goal we should all share: helping people recover and helping families survive the process with as much stability as possible.

In substance use disorder treatment, payment routing is not just paperwork. It is tied directly to recovery, access, and safety.

Hawaiʻi should act like it.