Benefit Elevation 101: What You Need to Know
August 25, 2020
Do you live in an area where there are no Ascension Network providers offering the specialized care you are seeking? If so, then this information about benefit elevation is very beneficial to you! SmartHealth created the benefit elevation program to assist members that live in areas where there are no Ascension Network providers for specialized care available. For example, this could be useful for people who have a local primary care physician (PCP), but don’t have access to a local cardiologist.
How does the benefit elevation program work?
Benefit elevation is used when an Ascension Network provider is not available within a 50-mile radius of a member’s home address zip code. You can request to use a National Network provider with the service covered as if you went to an Ascension Network provider.
If there are no National Network providers within a 50-mile radius, you can request benefit elevation for an Out-of-Network, or Tier 3, provider. When you request benefit elevation for an Out-of-Network provider, the service is covered at a National Network level. This National Network should be specified for your plan and it does not include just any National Network.
Why should I utilize benefit elevation?
Benefit elevation allows you to save money by having your claims paid at a higher coverage tier even though you are not within the radius of an Ascension Network provider. You can save money and all you have to do is apply for benefit elevation and get approved!
Benefit elevation for episodic care and dependents
There are also different types of benefit elevation situations. We cover benefit elevation for episodic care and dependents. Episodic care is defined as a pattern of medical and nursing care in which services are provided to a member for a particular care issue, without an ongoing relationship being established between the person and healthcare professionals. If you apply for this type of benefit elevation, you just have to make sure you fill out the specific form for that type of request. The same process is in effect for benefit elevation for dependents, which is especially helpful for college students living away from home. To request benefit elevation for a dependent or as a dependent whose current mailing address is more than 50 miles from an Ascension Network provider’s zip code on record, please fill out the benefit elevation request form for dependents. Remember that these two specific cases will require different forms than the standard benefit elevation form.
How can I apply for the benefit elevation program?
It’s as easy as filling out an online form. All you have to do is fill out a benefit elevation form for the specific type for which you qualify. Prior approval is required for all benefit elevation — you have to get approval before getting service. Forms can be found here.
Need additional help? Call 1 (844) 699-7573 or email email@example.com