A new requirement from one of Hawaii’s largest insurers is causing headaches for physicians throughout the state.

As of Dec. 1, 2015, the Hawaii Medical Service Association (HMSA) requires physicians to get prior authorization from a third party—National Imaging Associates—for all diagnostic imaging exams.

Honolulu physician Christopher Marsh, MD, shared his own frustrations in a letter to the Honolulu Star-Advertiser.

“Now HMSA routinely denies most heart and X-ray tests,” Marsh said, as quoted by the Associated Press. “They think or assume your doctor doesn't know what he/she is doing, and is too stupid to competently order tests on you. Or is a criminal, gaming the system, and benefiting illegally from ordering tests.”

Marsh called it “the hassle factor” in his letter, saying physicians don’t have 60-90 minutes to beg HMSA on the phone about paying for each test.

“These are tests that doctors almost always order,” Marsh said. “I have no stake in ordering these tests. In most of these cases it would be malpractice not to get them. It's been a huge stress and strain on our staff and it harms patient care.”

As the AP explained, many physicians avoided this pre-authorization before Dec. 1 thanks to a waiver that said they were trusted to make such decisions on their own. But HMSA changed the policy so that the waivers were no longer an option.

Elisa Yadao, HMSA senior vice president of consumer experience, issued a statement about the benefits of the requirement.

"Millions of health care dollars are spent each year on unnecessary medical care that doesn't improve the community's health and well-being," Yadao said, as quoted by the AP. "When we pay for unnecessary services, those costs are eventually passed on to everyone. By requiring pre-authorizations, we can reduce the number of unnecessary procedures, avoid our members being exposed to excessive radiation and lower costs."

HMSA has been serving Hawaii since 1938 and has approximately 1,600 employees throughout the state.