You may qualify for reimbursement if you paid for covered benefits within the past 180 days.
Medical expenses
If you receive emergency or urgent care services outside of San Diego or southern Riverside counties, you may be asked to pay for those services. If that occurs, you can request reimbursement from us. We will need a copy of the medical records for that
visit, an itemized bill and proof of payment in order to determine if the services are covered. Applicable co-payments will apply.
Prescriptions
In some cases, you may be asked to pay for prescription drugs that are normally covered by Sharp Health Plan. An example is when you are traveling outside of California and urgently need to fill a prescription. You can request reimbursement for covered
prescription drugs from us. In order to determine if the medication is covered, we will need a copy of the print-out from the pharmacy showing the medication you received and a receipt showing proof of payment. Applicable co-payments will apply.
Behavioral health expenses
If you receive care from an out of network behavioral health provider, you may be asked to pay for those services out of pocket. If that occurs, you can request reimbursement by logging in to your Optum Behavioral Health account. Once you are logged in,
go to the Claims section in the top menu and select Submit a claim. You will be asked to complete an online form and upload required documentation to determine if the services are covered. Then you can submit your claim. Applicable co-payments will
apply. You can also contact Optum Behavioral Health at 1-844-483-9013, to request assistance.
COVID-19 at-home tests
Sharp Health Plan will cover 8 individual at-home COVID-19 tests per month for each member. Tests may be packaged individually or with multiple tests in one package (for example, two tests packaged in one box). Tests submitted for reimbursement must be
authorized by the U.S. Food and Drug Administration (FDA). The FDA features lists of approved tests on its website.
To request reimbursement, you’ll need the brand name and the Universal Product Code (UPC) from the at-home test box. An itemized sales receipt is also required. The UPC is listed underneath the barcode and is typically a 12-digit number.