Have a complaint?

Let us know about any problems. We’re here to help.


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.

How to file a complaint

To start the grievance process, fill out our secure online form below, or download and print a paper form, and describe your situation in detail. Don’t forget to include specific information, such as where and when it happened, and what you believe Sharp Health Plan can do to resolve your concern.

If you choose to complete the paper form instead of filing your grievance online, you can mail it to:

Sharp Health Plan, Grievances and Appeals
8520 Tech Way, Suite 200
San Diego, CA 92123

You can also submit your grievance via fax at 1-619-740-8572.

 

About the grievance process

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan 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 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 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 (1-888-466-2219) and a TDD line
(1-877-688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.

If you would like to submit a written grievance directly to the department regarding the cancellation, rescission or nonrenewal of health care coverage, you can complete the paper form below. The form can be submitted via fax at 1-916-255-5241, or mailed to:

Department of Managed Health Care
Help Center
980 9th Street, Suite 500
Sacramento, CA 95814

Download the form

How we’ll respond

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, 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 any questions or need immediate assistance, please contact our Customer Care team at 1-858-499-8300 or toll-free at 1-800-359-2002. We are available to assist you from 8 am to 6 pm, Monday to Friday.

 

File a complaint online


 
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Your information

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Be sure to include your area code.

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Member information

About the member who is impacted by this complaint. If this section does not apply, click NEXT.
 
Member's gender

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Provider information

About the health care provider involved in this complaint.  If this section does not apply, click NEXT.
 

Be sure to include the area code.

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Appointed representative

If a representative has been designated or appointed for this complaint, enter their contact information here. If this section does not apply, click NEXT.
 

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Tell us more about your complaint.

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Please send us any supporting documentation you may have regarding this complaint/appeal. These include:

  • Copies of enrollee correspondence with Sharp Health Plan
  • Copies of proof of payment for the last paid coverage period
  • Copies of plan notices and correspondence received

Sharp Health Plan
Attn: Appeals & Grievances
8520 Tech Way Suite 200
San Diego CA   92123

(619) 740-8572
Attn: Appeals & Grievances