REFERENCE- BASED PRICING
Steve Shannon Tire partners with Imagine360 for those enrolled in the Reference Based Pricing Plan.
The following information regarding Imagine360 (formerly ELAP) and HealthSmart only applies if you are electing the RBP 1000 Plan!
WHAT IS REFERENCE-BASED PRICING
Steve Shannon Tire will continue to offer a plan under a Reference Based Pricing (RBP) insurance arrangement for the 2027 plan year. This arrangement differs from the traditional health insurance model you are used to.
Under RBP, you will not utilize the Highmark network of providers. Instead, you will have access to a small network of providers and facilities through the HealthSmart network. While you have access to this network, you are not required to utilize it. The RBP arrangement allows you to seek care from any provider you choose – there is no in-network or out-of-network. Providers and facilities are paid by the plan administrator based on the fair market value of the service. From there, providers can choose to accept this as payment in full, or they can choose to charge you more as the member. This is what is referred to as balance billing.
To help you navigate the Reference Based Pricing plan, HealthNow partners with Imagine360 (formerly known as ELAP). Imagine360 reviews claims to ensure you are not overpaying for services, and advocates on your behalf if you receive a balance bill. If you receive a balance bill, you MUST contact Imagine360 or Graham Company immediately – they will work to help you navigate balance billing and resolve on your behalf. Please note, while you may see any provider you choose, utilizing facilities in the HealthSmart network decreases your chances of being balance billed.
When enrolled in this plan, it is recommended you contact the Graham Company Concierge Team when scheduling services and/or paying for medical services. They will be able to help you navigate the RBP Arrangement by contacting your intended provider or facility ahead of time to ensure they are aware of the RBP arrangement and how it works, and helping to connect you with Imagine360 in the case of a balance bill.
Graham-Benefits@MarshMMA.com
1-888-842-1488
HOW IMAGINE360 WORKS
- Imagine360 works with Steve Shannon Tire to reduce healthcare costs. Overinflated healthcare charges cause plans to raise rates and members to pay more. Imagine360 eliminates this problem so that everyone pays only what’s fair.
- Imagine360 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. Imagine360 is your health plan’s partner for fairness and affordability!
- Imagine360 will work with HealthNow, who will process your medical claims after Imagine360 audits and reviews the claims.
IMAGINE360 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 Imagine360. They will work to open a case for your invoice.
The plan works with Imagine360 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 Graham or Imagine360 immediately.
HEALTHSMART PROFESSIONAL NETWORK
If you elect the third plan option, the RBP 1000 Plan, your plan includes a partnership with HealthSmart Network for practitioner & ancillary providers and built-in price protection from Imagine360. 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 Network will give you the best benefits from your health benefit plan. The HealthSmart Network works like other PPO networks. To find doctors and other professionals in the HealthSmart Network, click 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 Network, those professional services will be reviewed by Imagine360.
