Sharp Health Plan’s PPO plan is designed to give you the freedom to receive care the way you want. In our three-tier employer group plan, you can choose to receive care from Sharp HealthCare’s integrated care delivery system, the First Health® Network or any out-of-network providers of your choice. Behavioral health services, including mental health and substance use disorder services, are provided by OptumHealth Behavioral Solutions of California (Optum Behavioral Health).
You have regional access to Sharp Health Plan's award-winning care.
You have nationwide access to care through the First Health Network.
You have the freedom to access care with any licensed provider in the U.S.
Our PPO plan offers a large network of providers, so you can choose doctors, specialists and other providers at any time on your terms.
Choose to see a specialist at any time. You have the flexibility to see your preferred specialist without needing a referral from a primary care physician.
We recommend getting care from a provider within your network, but you can choose to go outside your network to receive care. Higher out-of-pocket costs may apply when you receive care from out-of-network providers.
The PPO Concierge Program is a free resource that gives you access to these benefits:
Our PPO Concierge, Yvonne Mascareno, is our members' guide to understanding how their PPO plan works. For immediate assistance, members should contact Customer Care at customer.service@sharp.com or by calling 1-858-499-8300.
We recommend reading your Member Handbook for details. You can access this by logging in to your Sharp Health Plan online account. You can also visit the FAQ to view provider directories for Tier 1 and Tier 2 and get more information about your plan.
To explore PPO plan options and find out if your group is eligible, please contact your dedicated account management executive. Please note that the PPO commission schedule mirrors the HMO schedule.
A Preferred Provider Organization (PPO) plan is a plan that allows members to choose from a network of preferred providers. Members do not select a primary care physician and do not need referrals to see other plan providers in the network.
Your plan allows you to receive care from your plan providers within Sharp HealthCare’s integrated care delivery system (Tier 1). You can also receive care from non-plan providers in the First Health® Network (Tier 2), or any out-of-network provider of your choice (Tier 3).
Services in Tier 1 and Tier 2 are the most cost-effective. Tier 3 services are out-of-network and typically cost more than services provided in Tiers 1 and 2.
Some services require approval from Sharp Health Plan before care is provided. This allows Sharp Health Plan to evaluate whether the care is medically necessary and eligible for coverage. Learn more about precertification.
You can choose an out-of-network medical provider, but costs may be higher.
Visit Optum Behavioral Health's online provider directory to search for a Tier 1 or Tier 2 behavioral health provider and filter by specialty, location and more to find the best fit for you. In Tier 3, you can choose an out-of-network behavioral health provider, but costs may be higher. If you need help selecting a provider, please call Optum Behavioral Health at 1-844-483-9013.
You can seek reimbursement for paid services from Sharp Health Plan. Please download and complete the reimbursement form. To be reimbursed for at-home COVID-19 tests, please download and complete this form.
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 will be 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.
If your preferred provider is not in our Tier 1 or Tier 2 network, you can access services from your preferred licensed provider using your Tier 3 out-of-network benefit level. Costs may be higher in Tier 3.
To nominate a provider to join the Tier 2 First Health Network, the provider must agree to the terms and conditions of being contracted with them. Please note that a nomination does not guarantee that the provider will join the proposed network. For more information, please contact customer care at 1-858-499-8300, Monday to Friday, 8am – 6pm.
FBT: SharpHealthPlan.com no longer supports this Internet browser. For the best experience on our website, please upgrade your browser to the latest version.