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If you want someone else to file your organization determination, coverage determination, appeal or grievance on your behalf, you must send us an Appointment of Representative Form or a legal document showing that you have chosen someone other than yourself to file for you and that this person has your permission to see all information including medical records about the appeal and/or grievance.
You may appoint any individual, including an attorney, to act as your representative to help you. A representative may be appointed at any time during the organization determination, coverage determination, appeal or grievance process. The person making the appointment and the individual accepting the appointment must either complete an appointment of representative form or provide the same requested information in another written format. If the form is not used, the written request must contain all of the elements. The appointment of a representative is valid for one year from the date it is signed by both you and the appointed individual.
You may obtain an aggregate number of grievances, appeals, and exceptions filed with Sharp Health Plan by calling Customer Care at 1-855-562-8853 (TTY/TDD users should call 711). For your convenience, our office hours are 8 a.m. to 8 p.m. 7 days per week from October 1 to March 31: 7 days per week 8 a.m. to 8 p.m. From April 1 to September 30: Monday through Friday, 8 a.m. to 8 p.m. and on weekends and holidays, your call will be handled by our voicemail system. A Customer Care Representative will return your phone call the next business day.
Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.