Exceptions to appointment wait times
Plan Provider may extend the wait time for an appointment if Plan Provider has determined and noted in the Member’s record that a longer wait time will not be detrimental to the Member’s health.
Plan Provider may also 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 |
Triage or screening services (24 hours/day and 7 days/week) | 30 minutes |
Interpreter services at scheduled appointments
Sharp Heath Plan provides free interpreter services for Members, whose primary language is not English, at scheduled appointments. Plan Provider may request interpreters by calling Customer Care: 1-800-359-2002.
Plan Provider must make requests for face-to-face interpreting services at least three (3) days prior to the appointment date. 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 Provider or Member may contact Customer Care for assistance if a Member is unable to obtain a timely referral to an appropriate provider: 1-800-359-2002.
Plan Provider or Member may contact the Department of Managed Care to file a complaint about a timely referral to an appropriate provider: 1-888-466-2219.