You need an expert resource with a proven reputation for successful medical and hospital bill negotiation who can ease the responsibilities and frustrations of managing your employees’ out-of-network health issues.
Managing out-of-network benefits and independent dispute resolution processes can be complex and demanding. But you don’t have to do it alone.
We can handle the entire out-of-network resolution process on your behalf, from managing reimbursement strategy through dispute resolution and arbitration under the No Surprises Act, saving your company time and money in the process. And when your employees are pleased with the outcomes, that reflects well on you.
As experts in the out-of-network space, Naviguard provides you with the detailed information you need to protect your employees and your company. Our resolutions are based upon data-driven, market-based pricing. That kind of transparency benefits everyone, especially your employees.
Our proven negotiation strategies position us to resolve the majority of out-of-network billing issues in advance of arbitration. For any situation that does proceed to arbitration under the No Surprises Act, you can count on Naviguard to provide informed compliance support, even with the new strict timeliness.
We put decades of health care experience to work for you. And it shows.
Savings for our employer clients to date
Cases resolved1
Average savings off billed charges2
Negotiation success rate3
1Naviguard data January 2021 – April 2023. Resolved cases include all instances in which a member contacted Naviguard and the case was reviewed and negotiated or closed.
2Naviguard data January 2021 – April 2023. Discount on all out-of-network paid claims (includes disputed claims and all other paid claims. Excludes denied claims.) Savings results shown may vary based on customer plan and geographic distribution and are not a guarantee of future results.
3Based on Naviguard’s engagement with its members during January 2021 – April 2023. Negotiation success rate is based on claims negotiated to less than billed charges. Negotiation success rate may vary and is not a guarantee of future results.
On January 1, 2022, the No Surprises Act (NSA) went into effect. Effective for members when their health plan year commenced in 2022, the NSA prohibits medical balance bills for patients like you for many — but not all — out-of-network services, when the member cannot control where or who they receive care from.
However, there are still situations when patients are not covered by the NSA. That’s where Naviguard comes in.
Under the NSA, providers of certain types of services will not be allowed to bill and pursue you directly for certain types of medical balance bills.
These include emergency services (except ground ambulance), or when an out-of-network provider is involved in your care while they are at an in-network facility.
In general, if a patient chooses to see a doctor or specialist who is not in-network, the NSA and its protections will not apply, and you may face much higher costs than the health plan’s in-network rate. The NSA does not protect patients from balance billing for ground ambulance services, or when the law’s notice and consent requirements are met.
Use these helpful resources when helping your employees with their out-of-network billing questions and issues.
Deductible, copay, and coinsurance are common terms in health care – but what do they really mean? And how do they affect you?
Learn More
On January 1, 2022, the No Surprises Act (NSA) went into effect, prohibiting medical balance bills for many — but not all — out-of-network services. However, there are still situations when patients are not covered by the NSA – and that’s where Naviguard comes in.
Learn More
Out-of-network means that no contract exists between the provider and insurance company. In many cases, out-of-network providers charge prices significantly higher than market rates.
Learn MoreHave a question for Naviguard or want to learn more about our out-of-network medical bill services?