6190 Powers Ferry Road
Suite 320
Atlanta, GA 30339
Filing a Grievance and/or Appeal
You or your authorized representative may file a grievance or appeal request either verbally or in writing.
Filing a Grievance
Examples of Grievances include but are not limited to:
- Quality of your care during a doctor’s appointment or hospital stay
- Waiting times on the phone or at your doctor’s office
- The way your doctor or others behave
- Not being able to reach someone by phone or obtain the information you need
- Lack of cleanliness or the condition of the doctor’s office
We will notify you or your authorized representative of the decision about your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after receiving your complaint. In some cases, we may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.
To file a Grievance and/or Appeal, you can contact Sonder Health Plans in one of these ways:
By Phone:
Call Sonder Member Services department at 888-428-2110 (press 1 for Appeals or Press 2 for Grievance)
- Grievance & Appeals Business Hours are: 8:00 AM – 5:00 PM (Monday- Friday); a voicemail message can be left for a callback within 24 hours.
By Mail:
- Grievances: Grievance@sonderhealthplans.com
- Appeals: Appeals@sonderhealthplans.com
Fax or mail the form:
If you prefer, you can download a copy of the form below and fax or mail to the below:
Fax number: 1 (941) 866-2319
Mailing address:
Sonder Health Plans
ATTN: Grievances & Appeals Department
6190 Powers Ferry Road
Suite 320
Atlanta, GA 30339
You can also file a complaint on Medicare.gov website
Appoint a Representative
In order for Sonder Health Plans to process a Grievance or/and Appeal request from someone other than you (the member), your physician, your prescribing physician (Part D), or other prescriber (Part D), we must have authorization from you. You may appoint any individual as your representative by sending us an Appointment of Representative form signed by both you and the representative. A representative who is appointed by the court or who is acting in accordance with state law may also file a request for you after sending us the legal representative form. You will not need to complete an Appointment of Representative Form if you provide an equivalent written notice or other legal representation document with your request.
For instructions on how to appoint a representative, Click Here.
To appoint a representative, you or your representative should complete the form entitled: Appointment of Representative CMS – 1696 (Spanish Version)
If you need a large print version of CMS 1696, Click Here (Spanish Version).
If you do not use form CMS-1696, your appointment must:
- Be in writing and signed and dated by you and your representative;
- Provide a statement appointing the representative to act on your behalf;
- Authorize the release of your personal health information to your representative;
- Include a written explanation of the purpose and scope of the representation;
- List your name and your representative’s names, phone numbers, and addresses;
- Include your Medicare Number (Health Insurance Claim Number or Medicare Beneficiary Identifier) or National Provider Identifier (NPI);
- Indicate your representative’s professional status, if any, or relationship to you; and
- Be filed with the entity processing your appeal.
Unless revoked, an appointment is considered valid for one year from the date the form is signed. Once the form is filed, it is valid for the duration of the appeal. Therefore, a signed form can be used for more than one appeal as long as the appeal is filed within one year of the date on the form.
In addition, there are certain individuals who can bring an appeal on your behalf, pursuant to State or other applicable laws. Such an individual, known as an “authorized representative,” may be a court-appointed guardian, an individual who has durable power of attorney, a health care proxy, or a person designated under a State’s health care consent statute.
You also can get the Appointment of Representative form on CMS’s website.
If you have any questions, please call Sonder Member Services department at 888-428-2110 (press 1 for Appeals or Press 2 for Grievance)
- Grievance & Appeals Business Hours are: 8:00 AM – 5:00 PM (Monday- Friday); a voicemail message can be left for a callback within 24 hours.
Contact numbers for members and physicians who have questions and need to inquire about the status of the Grievance and/or Appeal processes
Members:
Please call the Sonder Member Services department at 888-428-2110 (press 1 for Appeals or Press 2 for Grievance)
- Grievance & Appeals Business Hours are: 8:00 AM – 5:00 PM (Monday- Friday); a voicemail message can be left for a callback within 24 hours.
Provider/Physicians:
Please call the Sonder Provider Services department at 1 (888) 525-1730, Monday to Friday, 8 a.m. to 5p.m.
Our fax number is 1 (888) 216-5210
You can also find detailed information regarding grievances and the appeals process in the Sonder Evidence of Coverage (EOC). Links to the EOC can be found on the Documents/Forms page.
Utilization Management Statement.
Sonder Health Plan’s utilization management activities are designed so that they do not provide incentives, financial or otherwise, for the denial, limitation, or discontinuation of covered services by Plan staff or network providers.