The ProgramWhat is the EdisonHealth Network?
The EdisonHealth Network is a medical travel program sponsored by an employer's health plan. EdisonHealth contracts with some of the best medical centers in the country that have achieved outstanding success in treating patients. When using this program, the patient travels to one of our carefully chosen medical centers to be evaluated and treated for their complex surgery needs.Why should the participant travel for medical services instead of using his/her home physician?
EdisonHealth does not dispute the fact that there are viable surgeons everywhere, but there are other factors to consider when making a decision. Our medical centers routinely treat patients with complex medical conditions, and have a history of making the right decisions and achieving successful outcomes. With a reputation of low re-admission rates, the participant will have a better chance at recovery without complications.How does the EdisonHealth Network work?
The participant and a companion will travel to one of the EdisonHealth selected medical destinations. Most of the medical costs (co-pays, coinsurance, deductibles) and travel expenses (flight, hotel, food, transportation) for the participant and his/her companion will be paid for by the employer's health plan. The EdisonHealth Service Team will walk the participant through the necessary consent forms, schedule flights, coordinate transportation and book the hotel room. The participant will also be given a debit card for food purchases. EdisonHealth will work with the medical center's surgical team to ensure that they have the participant's medical records and that they schedule the evaluation appointment and surgery. The participant will receive an itinerary prior to the trip that provides the participant with pertinent travel information and contact phone numbers for questions. In most cases there will be a Nurse Navigator at the chosen medical center that will walk the patient to tests, appointments and surgery and will be the hospital contact to assist the patient and the companion.What happens at the chosen EdisonHealth medical center?
The medical center surgical team will meet with the participant to evaluate his/her medical condition and discuss potential treatment options. If surgery is recommended, it will proceed as planned. The surgery time will be confirmed and pre-surgical instructions will be provided. Once surgery is completed and the participant has been discharged from the hospital, he/she will stay in a designated hotel until the follow-up appointment when the participant's ability to travel will be evaluated and further recovery instructions will be given. If surgery is not the recommended course of treatment, the participant will be provided with an alternate plan of treatment. In either case, the EdisonHealth Service Team will schedule the travel home and communicate the plans to the participant. The Service Team will be available to answer any questions. After the participant's return home, the EdisonHealth Care Coordinator will help him/her understand the follow-up instructions provided by the medical team. Follow-up care may include physician appointments, physical therapy and additional testing.
ParticipationWho can participate in the program?
This program is for any plan member (employee, employee's spouse, employee's dependent child, etc.) of an employer's health plan that has contracted with EdisonHealth. The member must be currently enrolled in the medical plan and meet clinical criteria for the covered services.What qualifies a member for these services?
The covered health plan must be primary health care coverage for the member. The participating member must have been seen by their local physician within the last three months, and referred for medical treatment.How can an employee participate in the program?
An employee (or his/her dependent) can participate in the program by calling EdisonHealth at 1-866-982-7988. The EdisonHealth Service Team will qualify the participant and verify eligibility. Medical needs may be discussed with our EdisonHealth Care Coordinator.What does a participant need to provide EdisonHealth in order to obtain services?
The employee/participant will need to complete and return the EdisonHealth enrollment form and the medical release form.What does a participant need to provide the selected medical center in order to obtain services?
The participant will need to sign the medical release form that will give the local physician's office permission to release records to the providing medical center.Why are medical records required?
Medical records are needed by the medical center's surgical team for them to build an individualized treatment plan. Appointments will not be scheduled until the proper medical records have been received by the providing medical center.Is there a Member ID card provided? Who provides the Member ID card?
Yes, EdisonHealth will provide an ID card to use with this specific program. This card is only valid while receiving care under this program.
CoverageWhat medical services/benefits are paid for under the EdisonHealth program?
Most of the medical services associated with the surgery are covered including coinsurance, co-pays and deductibles. Most medically necessary services related to the condition after discharge from the hospital including physical therapy, follow-up visits or additional surgeries will also be covered under this program.What services/benefits are NOT covered under this program?
The following are not covered under this program: any elective outpatient services not related to the covered program services; convenience items (i.e. telephone, movies, hotel room mini-bar, laundry services, etc.); travel to and from the home airport; costs associated with unapproved flight changes.What travel expenses are covered?
- Airfare or travel allowance for the participant and a companion
- Lodging for the member before and after surgery and lodging for the companion for their entire stay
- A daily food allowance
- Concierge service to arrange travel and lodging
- Transportation between the airport, hotel and medical center
No. The medical center will be selected by the EdisonHealth team based upon the participant's individual medical need and the medical center's area of expertise.
TravelWho handles the travel plans?
The EdisonHealth Service Team will schedule and communicate all travel plans.Who qualifies as a travel companion?
The travel companion can be a family member, friend or caregiver. One travel companion is covered by the plan. The companion may only receive the benefits tax free if the companion is medically required or recommended by the home physician.Can the participant choose the hotel/airline that is used?
No. In order to receive travel benefits under this program, EdisonHealth must make all travel accommodations. Any airline or hotel reservation changes must be made through EdisonHealth.Is there a requirement for the participant to have a traveling companion?
Dependent minors are required to have a parent or guardian as a traveling companion. In many instances services rendered may require a parent or guardian's signature. Adults are not required to travel with a companion.
After Services are CompletedWhat happens if the participant experiences health issues once discharged from the hospital and while at home?
If there are any medical issues once the participant has returned home, the local physician and/or 911 should be called.Do claims need to be submitted to the current health insurance provider?
For services covered under this program, claims will not be sent to the participant. However, other health care services outside of this program will need to be coordinated with the participant's primary health plan coverage.What type of follow-up care is required?
The selected medical center will coordinate the transfer of care to the participant's local physician to allow uninterrupted quality of care. The scheduling of such follow-up care must be confirmed with the selected medical center and EdisonHealth prior to travel. Failure to confirm such follow-up care may result in the cancellation of the medical and/or benefits being reduced or denied.
Other InformationHow many times can a participant use this program?
A participant can use this program as many times as needed as long as he/she is enrolled in the health plan and meets clinical criteria for the covered services.How can someone receive more information about EdisonHealth Network?
By calling EdisonHealth at 1-866-982-7988.