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If you are having problems with Sharp Health Plan or a plan provider, give us a chance to help. You can file a formal complaint with a grievance form at any time. A formal grievance can be a complaint or an appeal.
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The California Department of Managed Health Care is responsible for regulating healthcare service plans. If you have a grievance against your health plan, you should first telephone your health plan at (858) 499-8300 or toll-free at 1-800-359-2002, and use your health plan's grievance process before contacting the department.
Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan or a grievance that that has remained unresolved for more than 30 days, you may call the department for assistance.
You may also be eligible for an Independent Medical Review (IMR). If you are eligible for an IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1.888.HMO.2219) and a TDD line (1.877.688.9891) for the hearing and speech impaired. The department's website, www.hmohelp.ca.gov, has complaint forms, IMR application forms and further instructions.
We will send you a letter to let you know that we received your grievance within five days and a decision letter within 30 days. If your grievance 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, we will provide you with a decision within 72 hours.
If you have any questions or need immediate assistance, please contact our Customer Care team at 858.499.8300 or toll-free at 1.800.359.2002. We are available to assist you from 8 a.m. to 6 p.m., Monday to Friday.