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Member Guidance

Enrollment Information

How to Enroll/Disenroll with Sonder Health Plans

Visit Our Office

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:

  • 8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31
  • 8 a.m. to 8 p.m. Monday-Friday from April 1 – Sept. 30
Fill Out the digital Enrollment Form

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

Enroll Through Medicare.gov

Medicare Beneficiaries may also enroll in Sonder Health Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov

Disenrollment
Rights & Responsibilities Upon Disenrollment

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, Waste & Abuse

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.

How You Can Protect Against Fraud, Waste, & Abuse

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.

Suspicious Activities include:

  • People trying to sell you health care items or services door-to-door or over the phone.
  • People who offer money or gifts for health care services.
  • People offering you free gifts or services in exchange for your Medicare ID number or health plan ID number.
  • Shipments of medical supplies you didn’t order.
  • Providers who tell you the item or service isn’t usually covered, but they “know how to bill” so insurance will pay.
  • Remember, if it seems too good to be true, it probably is.
  • Remember, if it Here are some other things you should be aware of to protect yourself from fraud, waste and abuse.seems too good to be true, it probably is.

Online theft of personal information

People may try to steal your personal or Medicare information online. They can harm you financially. They may also disrupt your healthcare benefits.

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.

Telemarketing scams

Many legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Medicare won’t call to ask for your bank account number, Social Security Number, Medicare ID number or health plan ID number and neither will Sonder Health Plans.

Here’s what you can do to protect yourself:

  • Hang up on recorded messages that ask you to verify your personal information.
  • Don’t press any keys or numbers when prompted – even if it’s to take your name off their list.
  • Never give your personal information to someone you don’t know.
  • Report suspicious numbers to the Federal Trade Commission.
  • Never give out your Social Security, Medicare ID number, health plan ID number or banking information to anyone you don’t know. You should only provide this information to people you know should have it.
  • Know who you’re sharing your personal information with.
  • Delete or ignore suspicious emails. Don’t click or download attachments you aren’t expecting. Legitimate email addresses usually end in .com, .org or .gov.

When it comes to your health services:

  • When you receive a bill for services review it carefully.
  • Make sure you received the services or items.
  • Check the number of services or items on your bill or explanation of benefits.
  • Be sure the same service isn’t on your bill more than once.
  • Verify the copayment amount is correct.
  • If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Ask about the services you received, such as: Why are they needed? Or, your provider may realize a billing error was made.
  • If you are unsure about information you have received about your benefits, please call our Member Services department at the number on your Sonder ID card.
What Do I Do When Fraud, Waste, & Abuse Happens?

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 [email protected].

Coverage Determination (Part D) Overview

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).

  • Prior Authorization (PA) –Some prescription drugs require prior authorization (PA) to be covered. If your prescription drug requires prior authorization, you, your appointed representative, or your prescribing physician or other prescriber will need to request and receive approval in advance from Sonder Health Plans before you fill your prescription. If you don’t get approval, Sonder Health Plans may not cover the drug.
  • Step Therapy (ST) – With Step Therapy drugs, Sonder Health Plans may request that you first try certain drugs to treat your medical condition before we cover another drug for that condition. If your drug has a step therapy requirement, your prescribing physician or other prescriber will need to provide a supporting statement to Sonder Health Plans. Approval must be received before you fill your prescription. If you don’t get approval, Sonder Health Plans may not cover the drug.
  • Quantity Limits (QL) – For certain drugs, Sonder Health Plans limits the amount of the drug that will be covered per prescription or for a defined period of time. If you require additional quantities over the limit, your physician will need to provide a supporting statement to Sonder Health Plans. An approval must be received before you fill your prescription for the additional quantity, otherwise the additional quantity may not be covered.

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.

Request a Coverage Determination
There are several ways in which you, your appointed representative, your prescribing physician, or other prescriber can request a coverage determination.

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

Request for Payment (Part D)
Please mail or fax us your written request for prescription drug payment reimbursement, along with proof of payment (bills, receipts) and/or a copy of the medical record documentation. Please make sure you provide detailed information. You can download a copy of the below Prescription Drug Claim Form Reimbursement Request Form or send us a letter with all the needed documentation. Please make sure to sign your request. We will notify you of our decision (and make payment when appropriate) no later than 14 calendar days after receiving your request.

Prescription Drug Claim Form

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.

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