When Insurance Delays Turn Deadly: Lessons from Nitta vs. HMSA

Insurance hurdles shouldn’t stand between a patient and timely medical care

If you ask any physician what makes their job so frustrating, you’ll likely hear the same answer: prior authorizations.

Insurance companies claim that prior authorizations are meant to promote efficiency and ensure best practices of care. But in reality, these requirements often place an enormous burden on both physicians and patients — delaying necessary treatments and sometimes leading to tragic outcomes.

A recent Hawaii Supreme Court case, Nitta vs. HMSA, highlights just how dangerous these delays can be. In this case, a patient’s treatment was denied pending prior authorization. While the physician navigated the appeals and arbitration process, the patient’s condition worsened, and the patient ultimately passed away.

The Hawaii Supreme Court later ruled that HMSA was in the wrong — but by then, the harm was irreversible.

This case is a sobering reminder that well-intentioned policies like prior authorizations can have serious, even fatal, consequences when they interfere with timely care.

At Ke Ola Noa, our Direct Primary Care (DPC) model takes a different approach. Because we don’t bill insurance, we’re not required to obtain prior authorizations for diagnostics, treatments, or medications within primary care.

Instead, we focus on what truly matters: the doctor–patient relationship. By removing the barriers of third-party payers, we can provide faster, more personal, and more compassionate care — the kind of care every patient deserves.