Sutter Health Plus Grievance Form

If you have concerns with Sutter Health Plus or a Sutter Health Plus provider, give us a chance to help. You have the right to submit a complaint or grievance at any time. A grievance is a written or oral expression of dissatisfaction. Grievances include, but are not limited to, quality of care concerns, requests for review of denied services, benefit coverage decisions, and cancellations, rescissions and nonrenewals of your healthcare coverage.

You have 180 calendar days from the date of the event that caused your dissatisfaction to submit a grievance.

Sutter Health Plus handles all member information in a confidential manner. We do not discriminate against any member who submits a grievance. Please fill out the Grievance Form or call the Sutter Health Plus Member Services Department at (855) 315-5800 or TTY (855) 830-3500 to file a grievance. Member Services is available 8:00 am to 7:00 pm, Monday through Friday. You can submit your completed Grievance Form by mail or fax. You can also request a grievance online (after logging into the member portal). Page two of the Grievance Form has contact information for mailing or faxing your grievance.

Continuity of Care

Continuity of Care (COC) lets members temporarily continue care with a provider who is not part of the Sutter Health Plus network. Members may be eligible for COC if:

1. They are new Sutter Health Plus small or large group members receiving active treatment and their treating provider does not accept Sutter Health Plus
2. They are new Sutter Health Plus individual and family plan (IFP) members whose prior coverage was terminated because their previous health plan withdrew from the market or discontinued their previous benefit plan.
3. They are existing Sutter Health Plus members whose provider leaves or is terminated from the Sutter Health Plus network. 

For additional COC eligibility criteria and more information, please review Continuity of Care Request Form and Guidelines.

DMHC Grievance Form for Cancellations, Rescissions, and Nonrenewals of an Enrollment or Subscription

If you believe your health care coverage has been, or will be, improperly cancelled, rescinded or not renewed, you have the right to file a grievance with the plan, and/or the Department of Managed Health Care (DMHC).

You have 180 days from the date you receive the Notice of Cancellation, Rescission or Nonrenewal from Sutter Health Plus to request a grievance.

To file a grievance with the DMHC, please complete the DMHC Grievance Form for Cancellations, Rescissions and Nonrenewals of an Enrollment or Subscription. For more information on your grievance rights and options, refer to the Right to Submit Grievance for Cancellation, Rescission or Nonrenewal of your Plan Enrollment Subscription or Contract document.

World Professional Association for Transgender Health (WPATH)

Sutter Health Plus promotes excellence in transgender and gender diverse health care by following the current version of the WPATH Standards of Care (SOC). The WPATH link provides access to the SOC. It also provides access to materials that can help individuals understand the SOC and how they form the basis for medical necessity determinations.