For Covered Plan Members
Healthcare expenses have continued to spiral upwards, and the annual costs, if left unchecked, can impact your employer's ability to offer heath care benefits. Your employer has implemented a “self funded” benefit plan, and has taken certain steps to control costs related to healthcare coverage. The goal of the plan is to ensure that each employee has access to medical coverage and that plan assets are being spent wisely.
In order to control annual health care cost increases -and to control the amount of employee “out of pocket” contributions- your employer has hired ELAP Services to closely monitor the plan. ELAP is an “affiliate business partner” to the plan and is bound under strict laws to ensure patient confidentiality and regulatory compliance. ELAP’s services Include:
- Auditing and repricing certain healthcare providers’ billed charges to ensure compliance with our plan limits
- Representing your interests in any disputes with the provider
- Ensuring compliance with all relevant regulatory guidance
In many cases, the provider has requested an amount of compensation that exceeds what the plan is permitted to pay. The difference between the provider invoice amount and plan payment may be substantial. ELAP will enforce the plan’s decision on payment and defend that decision with their legal counsel at their expense.
In the event that a provider sends you an Invoice for the unpaid balance, ELAP will handle this “balance bill” and assign an attorney to defend you if necessary. There is no cost to the employee for ELAP's services or for any legal representation.
What to do if you receive a “balance bill”?
If you receive a bill from a medical provider or collection firm, contact ELAP Services at once.
Please include on your cover sheet:
Name of your employer, date of service, name of provider