Haw. Code R. § 16-23-103 - Rules of decision for allowable fees for medical, surgical, and hospital services and supplies
(a) When all the
required care for a case reasonably falls within the range of qualifications of
one health care provider, no other health care provider may claim a fee, except
for consultation service or for surgical assistance. For groups of health care
providers or hospitals with satellite clinics, when service is rendered by a
group member of the same specialty, the group shall submit bills as though one
health care provider had cared for the claimant.
(b) Medical, surgical, or hospital care of an
unusual type or unlisted fee may occur which represents a type of service over
and beyond listed procedures. Appropriate fees may be allowed if the treatment
was reasonable, appropriate, and necessary.
(c) Medical conditions or symptoms which are
pre-existing and are not aggravated or affected by and do not result from the
injury covered by motor vehicle insurance benefits shall not be compensable.
Palliative treatment of these unrelated conditions shall be allowed, provided
that these conditions directly retard, prevent, or endanger the surgical care
or recovery from the injury covered by motor vehicle insurance benefits. In
addition, pre-existing conditions which did not require treatment before the
motor vehicle accident resulting in accidental harm but which do require
treatment as a result of the accident shall be compensable. Pre-existing
conditions which required treatment at the time of the accident and which are
aggravated or affected so as to require additional treatment shall be
compensable to the extent of the additional treatment.
(d) Certain of the procedures listed in
medical fee schedules are commonly carried out as an integral part of a total
service and do not warrant a separate charge. When such a procedure is carried
out as a separate procedure, not immediately related to other services, the
indicated fee is applicable.
(e)
Minimal dressings, counseling incidental to treatment, etc., are covered by the
office visit fee. Necessary drugs, supplies, and materials provided by the
health care provider may be charged for separately in accordance with section
16-23-114.
(f) Fees including office visits shall not be
paid for more than one visit per day by the same health care provider of
service regardless of the number of injuries or conditions treated.
Notes
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