Presentar una queja formal o apelación

Tell us about concerns with your coverage or care.

Si tiene problemas con Sharp Health Plan o con un proveedor del plan, denos la oportunidad de ayudarlo. You can always contact our Customer Care team at 1-800-359-2002 for support. You may also file a grievance or appeal with us. A grievance is a formal complaint. An appeal is a request for us to reconsider a decision about your coverage.

• Member Grievance & Appeal Form (PDF)

Instrucciones

Follow these instructions when filing a grievance or appeal:

• File a grievance or appeal with Sharp Health Plan up to 180 calendar days after any incident that is subject to your dissatisfaction. Your request will be acknowledged within five calendar days of receipt and resolved within 30 calendar days.
• If you feel your request is urgent in nature, call Customer Care at 1-800-359-2002. Examples of urgent requests include:
  • An imminent and serious threat to your health, including but not limited to severe pain or potential loss of life, limb or major bodily function
  • A concern related to cancellation, rescission or nonrenewal of coverage
• Be specific when you describe your concern. Provide details such as:
  • Where and when it happened
  • What you believe Sharp Health Plan can do to resolve your concern
• Include relevant documents with your form. Examples include:
  • Statements: Premium billing statement, provider bill
  • Proof of payment: Receipts, a copy of the front and back of a canceled check, credit card statement
  • Correspondence: Plan notices, letters

File a complaint by mail, in person or fax

Download a copy of our grievance and appeal form.

• Member Grievance & Appeal Form (PDF)

Fill out the form electronically and print it out, then send it to us by mail, in person or fax. Keep copies of any documents you send to Sharp Health Plan for your records.

Por correo o personalmente

Atención: Quejas formales y apelaciones
Sharp Health Plan
8520 Tech Way, Suite 200
San Diego, CA 92123

Por fax

Atención: Apelaciones y quejas formales
1-619-740-8572

Presente una queja en línea

Qué esperar

Within five days, we’ll send you a letter to let you know we received your grievance.

A decision letter will be sent within 30 days.

If your request is urgent and involves an imminent and serious threat to your health, including but not limited to severe pain, potential loss of life, limb or major bodily function, or any complaint regarding the Plan’s cancellation, rescission or nonrenewal of coverage, we will provide you with a decision within 72 hours.

If you have questions or need immediate assistance, please contact Customer Care at 1-858-499-8300 or toll-free at 1-800-359-2002. Estamos disponibles para ayudarlo de lunes a viernes de 8 a. m. a 6 p. m.