If an appointment requires rescheduling, the appointment shall be promptly rescheduled in a manner that is appropriate for the member’s health care needs and continuity of care, consistent with good professional practice.
Extended wait times
Plan providers may extend the applicable wait time for an appointment if they have determined and noted in the member’s record that a longer wait time will not be detrimental to the member’s health.
Plan providers may schedule appointments in advance for preventive and periodic follow-up care services (e.g. standing referrals to specialists for chronic conditions, periodic visits to monitor and treat pregnancy, cardiac, or mental health conditions,
and laboratory and radiological monitoring for recurrence of disease) consistent with professionally recognized standards of practice, and exceed the listed wait times.
Telephone wait times
|Service||Maximum wait time|
|Sharp Health Plan Customer Care|
(Monday to Friday, 8 am to 6 pm)
After-Hours triage services
PCP, mental health providers and substance abuse disorder providers are required to have an answering service or a telephone answering machine during nonbusiness hours. These services must provide direction to a member on how to obtain urgent or emergency care and, if applicable, how to contact an on-call provider for screening or to receive urgent or emergency care as appropriate.
Interpreter services at scheduled appointments
Sharp Health Plan provides free interpreter services for members at scheduled appointments whose primary language is not English. Plan providers can request interpreters by calling Customer Care at 1-800-359-2002.
Plan providers must make requests for face-to-face interpreting services at least five (5) business days prior to the appointment date. Coordination of interpreter services shall not impose delays on the scheduling of the appointment. In the event
that an interpreter is unavailable for face-to-face interpreting, Customer Care can arrange for telephone interpreting services.
Concerns about timely referral to an appropriate provider
Plan providers or members can contact Customer Care at 1-800-359-2002 for assistance if a member is unable to obtain a timely referral to an appropriate provider. Plan providers or members can also contact the California
Department of Managed Health Care at 1-888-466-2219 to file a complaint.
If you have any questions, please contact our Provider Relations Team at firstname.lastname@example.org or 1-858-499-8330. We are available to assist you Monday – Friday, 8 am to 5 pm.