Sharp Health Plan

Buyer beware. this is a warning to all Sharp Healthcare nurses that have Long term disability coverage. God forbid that you have any horrific period in your life in which you may need to rely your disability policy offered through Sharp Healthcare. My advice would be to purchase a supplemental plan outside of the organization. Sharp does a great job in providing care to the community, but when it comes to employees, I suggest every nurse, read the fine print. You will find that in the event of a need for benefits to bridge you until you can come back to work, you will not be happy with the decisions made by the insurance providers in which Sharp Healthcare contracts with.

While I like the insurance coverage, the hassle of dealing with their terrible internal systems isn’t worth it. When trying to fill a prescription on March 15^th I found out my insurance was suspended. I was furious. I called Sharp to find out that they had suspended my insurance due to a balance. Here was what I received on my statements:
January: no payment due due to previous over payment. Credit of $ 110.
February: credit of $ 110 applied balance due $ 331 must pay by ²⁄₂₉
I paid the balance due on February on ²⁄₂₂ and yet my insurance was suspended sometime in early March. They are claiming it was a mess up in their system and that the statements had been incorrect and that I should have paid the full amounts. Here’s the kicker– I was actually due a credit. Get your accounting act together sharp. I get it you are a healthcare company — not an accounting company but that’s just part of doing business.
I won’t be renewing with Sharp… because you know what’s the point if you pay and don’t have insurance anyway.

Sharp Health Plan has been the worst company to deal with. First, they removed my 1 month old son from my health insurance plan and told me I didn’t file the correct paperwork. I checked with my HR Department and the paper work was filed, which means Sharp lost it and rather than contact me, they just removed him from the plan. My son’s physician’s office contacted me to alert me to what had happened. Next, their customer service is terrible. Customer service representatives are inconsistent and not knowledgeable regarding company policies and getting anything done is next to impossible. We recently switched from a Blue Cross PPO. I’m sad to say that it was a terrible decision. Will definitely be switching companies next time open enrollment comes around. STAY AWAY.

Sharp is a bureaucratic nightmare. Customer service wait times can be very long. Last time I gave up after 15 minutes and opted for the ‘leave your number and we’ll call you back within 24 hours’ feature. Didn’t get a call back. Bigger problem is why patients need to call customer service so often in the first place. In my case:
1) First time I went in to pick up a prescription after joining Sharp it was denied at the pharmacy checkout. Lengthy process to get this sorted out.
2) Can’t use their website to sort things out since member registration often appears to be down. System is still giving me one of those ‘temporary system error’ messages.
3) Sharp failed to send a membership card for my wife though she is also on the policy. Had to call to get this straightened out.
4) Sharp billing department called a few months ago seeking payment for services rendered by a Sharp clinic two years ago. After two phone calls (wasting 60+ minutes), I finally had to send copies of my credit card statement to prove I’d already paid for it. Their billing bureaucracy has still not sorted out where this money went. In the meantime they continue to send letters demanding payment and threatening late fees. Another phone call was required to get the letters to stop.
If you have a choice of healthcare I would strongly recommend looking elsewhere.

Terrible customer service. Called and recording just said everyone was busy and would call me back the next day. Really? Is that what I want from my insurance company?
Then I called another number, 18 minute hold, only to be cut off. Called again and was told that they don’t send a bill for the first month but expect payment. Told them I would pay, but since it was retroactive to the first of the month, I needed to see a doctor today. They said it takes 48 hours to process.
Worst service EVER! I’m strongly recommending against renewing with them!

Wow, I’ve had Cigna, Blue Shield before — I had no no idea that medical insurance experience can vary so significantly depending on the company. Turns out it can — never ever I’m going to get a Sharp plan again. Can’t wait for open enrollment period to switch company. In short — everything needs to be authorized, which takes forever. Plus customer service issues. No, thank you.

RUN, don’t walk away from this health plan. A true HMO in every way, cutting corners and costs, never for the best interest of the patient. If you require a specialist, even for a serious condition, you may wait months and then be treated like cattle. Specialist didn’t even seem competent and was basically rude. Then for test results, couldn’t get a returned phone call or response. Substandard care and not worth the wait… so unfortunate. They need to rephrase their «Sharp Experience» marketing theme to «Sharp Horrible Experience».

I was given Sharp’s Health Plan as a choice by Covered California. I also volunteer at Sharp’s Hospital and can testify that the quality of health care is by far the best I have seen or heard about. Because of all this positive experience I quickly chose the Silver Plan of Sharp’s and signed up. I received my bill in the mail and tried to pay but the site would not let me with out an account number. I even placed my credit number in the box with my personal info. I called the phone number given in the letter and left a voice mail. In four days I didn’t receive a return call so I called again and left another voice mail. No return call again and even after 2 more calls with voice mail. It’s painfully obvious that if the management of Sharp’s Heal Plan is this inept and careless then no matter how good the quality of their care is it is useless if I can’t pay and actually receive the care. As I read the other Unilocal posts I see I am not the only one with this same problem. How sad that such good health care is wasted by poor management. I suggest Sharp’s Health Care do something about this poor service.

I have a Sharp HMO health plan. I must tell you if you want to see specialist in Sharp Rees Stealy then you have to wait for an appointment for at least three months. I called last week to make an appointment with dermatologist in Sharp at Rancho Bernardo locations for my son and I was given appointment to July 2015, 5.5 months from now. When I asked why secretary replied rudely doctor is busy. Then I called Sorrento mesa location, earliest that I can get in late April.
Anytime I get referral to see specialist from my primary, Unfortunately it takes at least three months to see specialist. I was given to see podiatrist 3.5 months and to see Neurologist 2.5months.

With all the tools available to make the right choice as well as the intend of the ACA to bring more clarity into the health care market I believe that I made a fairly decent choice. However, health insurances somehow cannot refrain from making a few things very questionable.
My point in case: As a Type I Diabetic I will have to do blood test every 3 month to verify the control of the blood sugar levels as well as detecting and preventing any further issues/​disease with this condition. You might want to believe that with their Platinum 90 HMO this would fall under «Preventive Care» at no $ cost as «Laboratory, radiology and other services for the early detection of disease when ordered by a physician». Low and behold this is not the case and I am billed for every single blood draw under «Professional Services: Laboratory tests and services».
On top of this I had some physical complains which prompted my Doctor to order some Lab test, of course, you guessed it, at the cost of $ 20 per test. Those test led to the detection of a tumor, hopefully benign, which is treated by medication and hopefully will shrink. In order to verify that the meds are working, you guessed correct again, I need to do Lab tests at $ 20.
All in all this health plan is still cheaper than comparable plans but these co-​pays add up. And my biggest issue is the language they use where I believe that all those Lab tests billed should actually be «preventive care» and «early detection».
The language in the plan and a snobby reply when I questioned these cost just force me to give 2 stars, not so much for having «experienced better» but for «should experience better».
The actual Dr’s and facilities deserve better but obviously should be reviewed in a different place.

You would think that if you have the sharp health plan you would be covered at sharp urgent cares, not the case. We found this out the hard way when we showed up at the clinic downtown and then had to drive to La mesa for a visit. This wasn’t the worst part, we get to the clinic and there are over 9 people waiting and only one doctor, and over an hour wait.
I guess we should have gone with Kaiser…

My son is a full time college student away from home. He has expressed a need to see a counselor. According to Sharp he has to be seen in San Marcos, two hours away from school. The only way for him to be seen «out of network» is for him to call some case manager and have her determine if it is medically necessary. I will NOT ask my 19 year old to call some stranger and convince her he needs to see a counselor. Mental health counseling is a a private and personal situation and for my son to ask to see a counselor was a huge step. Sharp Healthplan has the WORST mental health coverage and I have never had coverage that makes it this difficult for someone to talk to a professional. Especially with the healthcare reform act. I am outraged and disgusted. Rest assured my son will see a counselor near his school at my out of pocket expense because our health plan has let us down is the worst possible way.

Have had kaiser all my life and got a new job and switched to Sharp Health Plan. I was a little hesitant but have had a great experience! Excellent customer service, they helped me through the change from kaiser to them. So happy I switched.

I had to give up Kaiser when I quit work to go back to school and got on G’s plan from his job — at Sharp.
This plan sucks. they don’t cover ANYTHING! No hepB vaccine, no TB test, not even some pretty common drugs. Everything has to be «authorized» taking forever to get anything done. It took 6 months from first calling the primary care Doc to getting through tests, specialists and results to find out I’m not going to die of breast cancer this year.
Kaiser spoiled me. All vaccinations and tests are covered. The Dr. won’t prescribe something that will be refused. You can email your Dr. And test results available online. From Sharp, I get a letter, way late, telling me my test results are normal, but no actual results. Some tests are open to interpretation, so I want to know the number results.
I don’t know why people opposed to health care reform cite Canada as being so terrible. I feel like my experience with Sharp is about the same as socialized medicine.
I just hope when I get a job I will have a choice of Kaiser.