File a grievance or appeal

Tell us about concerns with your coverage or care.

If you are having problems with Sharp Health Plan or a plan provider, give us a chance to help. 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)

Instructions

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.

By mail or in person

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

By fax

Attention: Appeals & Grievances
1-619-740-8572

File a complaint online

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Your information

* denotes a required field

Who are you?*

Who is this complaint for?*

Your first name*

Your last name*

Your email address*

Daytime phone number*

Be sure to include your area code.

Evening phone number

Your primary address*

City*

State*

ZIP 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 first name

Member last name

Member ID #

Member date of birth

Member's gender

Male

Female

Other

Member's plan medical group

Member's preferred language

Member's phone number

Be sure to include the area code.

Member email address

Member mailing address

Member city

Member state

Member ZIP code

What to expect

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. We are available to assist you Monday to Friday, 8 am – 6 pm.

About the grievance process

The California Department of Managed Health Care (DMHC) 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.

You have the right to submit grievances to the plan and the DMHC for the failure of Plan staff to provide trans-inclusive health care, which may include Plan services or health care services rendered by Plan providers. Trans-inclusive health care is defined in Section 1367.043(d)(3) as comprehensive health care that is consistent with the standards of care for individuals who identify as TGI, honors an individual's personal bodily autonomy, does not make assumptions about an individual's gender, accepts gender fluidity and nontraditional gender presentation, and treats everyone with compassion, understanding, and respect.

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.