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We want to make sure you are well informed about all the benefits that are made available to you. We have an expert team of certified Sales Associates, who are ready to visit you and help answer any questions you may have. We can also set you up with a licensed agent who will be ready to help you enroll.
To schedule an appointment, please contact us at: (888) 217-7110
Hours of Operation:
Our enrollment application may be accessed by clicking here to be filled out.
Should you need to send a paper form, please feel print our enrollment application here and send your completed enrollment form to :
Sonder Health Plans, Inc.
Member Services Department
6190 Powers Ferry Road
Suite 320
Atlanta, GA 30339
Medicare Beneficiaries may also enroll in Sonder Health Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov
Sonder Health Plans, Inc., upon receipt of a disenrollment request, will send you a disenrollment acknowledgement letter within ten (10) calendar days. Once CMS confirms the disenrollment, the plan will send you a disenrollment confirmation letter. These notices include explanations of restrictions during the lock-in period and the effective date of the disenrollment. You must continue to use the plan until the disenrollment is effective.
If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment. If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.) See Chapter 6, Section 9 of your EOC for more information about the late enrollment penalty.
As a member of the plan it is your responsibility to notify us if you have moved out of the plan service area. If you are not sure if you moved out of our area, please contact the Member Services Department (800) 311-2928. TTY users should call 711.
We are open October 1 – March 31: 7 days a week, from 8:00 a.m. to 8:00 p.m., Eastern Standard Time and April 1 – September 30: Monday through Friday, from 8:00 a.m. to 8:00 p.m., EST.
Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any healthcare benefit program or to obtain any of the money or property owned by, or under the custody or control of, any healthcare benefit program.
Waste is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.
Abuse includes actions that may, directly or indirectly, result in unnecessary costs to the Medicare program, improper payment, payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowing and/or intentionally misrepresented facts to obtain payment.
You can help protect yourself from fraud, waste and abuse.
Health care fraud, waste and abuse affects all of us. It impacts the quality of health care and results in higher medical and prescription costs. There are many different types of fraud, waste and abuse. It’s important to be able to identify these issues and know what to look for to protect yourself from identify theft and benefit fraud.
It’s not always easy to tell the difference between an important email about your benefits and an online scam. An email may say there’s a problem with your account. Or it may ask for updated information to continue your healthcare coverage. When in doubt, give us a call at the Member Services number on your Id card. We’re here to help.
Here’s what you can do to protect yourself:
You can report your concerns to us.
If you see something suspicious or have a question about your plan statement or benefits, call our Member Services department at the number on your ID card.You may also report your concerns anonymously by calling the Sonder Fraud Hotline toll free at (470) 298-7677.
You can also report suspected fraud or abuse directly to Medicare. Call the Medicare fraud tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950. Email: You can also send up to 10 pages describing the incident to HHSTips@oig.hhs.gov.
A Coverage Determination means any decision made by Sonder Health Plans regarding payment or benefit to which you believe you are entitled to. A coverage determination is necessary when a formulary medication requires a Prior Authorization (PA), Step Therapy (ST) and/or Quantity Limit (QL).
PA, ST and QLs help ensure the best use of your benefits and that you receive the most appropriate treatment. It also avoids the potential misuse and abuse of medication.
Exceptions, such as tiering exceptions and formulary exceptions, also require a coverage determination. A tiering exception is when you believe you should get your drug at a lower cost share. A formulary exception is when you believe you need a drug that is not on the plan’s formulary. All exception requests must be supported by a statement by the prescribing physician.
Sonder Health Plans will make standard coverage determinations within 72 hours and expedited coverage determinations within 24 hours.
Call Member Services toll-free at (800) 331-2928 (TTY: 711), 7 days a week, 8AM to 8PM EST
Download and complete a Coverage Determination form. Supporting documentation will need to be submitted by the prescribing physician or other prescriber to demonstrate medical need.
Mail the completed request form to the plan’s Pharmacy Department address:
Sonder Health Plans, Inc.
ATTN: Pharmacy
Department
6190 Powers Ferry Road
Suite 320
Atlanta, GA 30339
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.
