Member Advocacy & Defense
‘Standing In The Shoes’ Of Members
Medical providers are entitled to a fair payment for their services and a plan is obligated to make that payment. The ELAP process seeks to identify the medical provider’s actual cost to deliver the service and to allow a fair margin above that cost, always in accordance with the clear language of the Plan Document.
Should a medical provider pressure or threaten a plan member in a balance bill situation, ELAP will provide legal defense to the member and the plan. Medical providers are given full appeal rights and are encouraged to submit all supporting documents in support of their request, but plans have a fiduciary obligation to be prudent stewards of plan assets. ELAP will defend the plan and the member to assure plan assets are protected against unfair billing and collection practices.