REFERENCE BASED PRICING
ELAP partners with HealthNow and Steve Shannon Tire for those enrolled in the Reference Based Pricing Plan.
The following information regarding ELAP and HealthSmart only applies if you are electing the RBP 1000 Plan.
If you are interested in enrolling, please reach out to the Graham Company Concierge for a comprehensive overview of the plan. Because this plan operates differently from traditional insurance models, we ask that all prospective enrollees connect with Graham to ensure a clear understanding before making a decision.
WHAT IS REFERENCE BASED PRICING
Steve Shannon offers the RBP 1000 plan through a Reference Based Pricing (RBP) insurance arrangement, which differs significantly from traditional health insurance models. Unlike other plans that use the Highmark network, this plan provides access to a smaller network of providers and facilities through the HealthSmart and Partners Direct Health (PDH) network. However, you are not required to use this network—you may see any provider you choose, as there are no in-network or out-of-network restrictions. Under the RBP arrangement, providers and facilities are reimbursed by the plan administrator based on the fair market value of the services rendered. Providers may accept this payment as full compensation or may bill you for the difference, a practice known as balance billing. While you have freedom of choice, using providers within the HealthSmart and PDH network reduces the likelihood of balance billing.
To assist you in managing the RBP plan, HealthNow partners with ELAP, which reviews claims to ensure you are not overcharged and advocates on your behalf if you receive a balance bill. If you do receive a balance bill, it is essential to contact ELAP or the Graham Company immediately—they will help you navigate and resolve the issue.
When enrolled in this plan, please contact the Graham Company Concierge Team before scheduling or paying for medical services. They are available to guide you through the RBP arrangement and help you make informed decisions.
HOW ELAP WORKS
- ELAP works with Steve Shannon Tire to reduce healthcare costs. Overinflated healthcare charges cause plans to raise rates and members to pay more. ELAP eliminates this problem so that everyone pays only what’s fair.
- ELAP establishes and enforces fair limits on what the health plan will pay for healthcare services and audits claims to ensure that you pay a fair and reasonable price for your healthcare. ELAP is your health plan’s partner for fairness and affordability!
- ELAP will work with HealthNow, who will process your medical claims after ELAP audits and reviews the claims.
ELAP MEMBER SERVICES
Your dedicated Advocate is your main line of support, continually monitoring the progress of your account while proactively keeping you up to date.
Have a question? Call or email your Advocate at any time/ You'll get a response within 24 hours.
Phone: 1.800.977.7381
Email: bb@elapservices.com
Fax: 1.888.560.2447
Mail: 1550 Liberty Ridge Drive Ste. 330 Wayne, PA 19087
BALANCE BILLING
How Do I Know If I'm Being Charged Too Much?
After receiving medical care, you will get an Explanation of Benefits (EOB) from your plan administrator specifying what you owe for services. If you receive a bill for more than this amount, immediately contact Graham or ELAP. They will work to open a case for your invoice.
The plan works with ELAP to ensure the following resources:
- Member Service Advocates to assist you throughout the balance billing process. The Advocate will work closely with you as they work to resolve the balance billing issue. All we ask is cooperation and patience as the Advocate takes the lead on working through the process.
- An expert team to assist members with all billing issues. You will be requested to sign and return a HIPAA form for medical records release and a signed Attorney-Client Representation Agreement. If you receive a balance bill, please contact UMR immediately at 1-800-972-3025.
HEALTHSMART PROFESSIONAL NETWORK
If you elect the third plan option, the RBP 1000 Plan, your plan includes a partnership with HealthSmart and Partners Direct Health (PDH) Network for practitioner & ancillary providers and built-in price protection from ELAP Services. Each of these services will apply to a different part of your healthcare services.
Professional Services
Think of professional services as a doctor or surgeon’s time and expertise. Professional service fees pay healthcare professionals for the service they perform for you. Those services could be a routine check-up or surgery.
Using providers in the HealthSmart and Partners Direct Health (PDH) Network will give you the best benefits from your health benefit plan. The HealthSmart and PDH Network works like other PPO networks. To find doctors and other professionals in the HealthSmart and PDH Network, use the button below.
Facility Services
Facility service fees, then, cover the building, equipment or tools the professionals use, and certain staff in the facility. “Facilities” are the setting in which you receive care. Facilities include hospitals, free-standing surgery centers, and any outpatient facilities. Your plan does not include facilities in its PPO network. You can go to any facility you want because your plan works with ELAP Services to review facility claims, which includes ER visits, hospital stays, and certain imaging and testing procedures. In addition, if you don’t go to a doctor in the HealthSmart and PDH Network, those professional services will be reviewed by ELAP.
