Guidance for Employers Out-of-Network Billing Negotiation
Let Naviguard handle all the responsibilities of out-of-network billing resolution.
WHY NAVIGUARD
Out-of-network billing conflicts are a time-consuming burden.
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.
Naviguard will help ensure that your out-of-network program:
- Keeps your employees healthy, happy, and covered in all out-of-network billing disputes.
- Positions you for the best negotiation and arbitration results and helps avoid overpayment for services.
- Adheres to the new timelines, reimbursement justification, and reporting and submission rules of the No Surprises Act.
- Allows you to optimize your program costs, now and in the future.
Our Solutions
Count on the Experts
Managing out-of-network benefits and independent dispute resolution processes can be complex and demanding. But you don’t have to do it alone.
Flexible service that pays off
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.
Industry expertise you can depend on
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.
Trusted ally with a track record of success
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.
Real Results
The proof is in the numbers.
We put decades of health care experience to work for you. And it shows.
$3.5B+
Savings for our employer clients to date
136K+
Cases resolved1
60%
Average savings off billed charges2
84%
Negotiation success rate3
1Naviguard data January 2021 – October 2022. Resolved cases include all instances in which a member contacted Naviguard and the case was reviewed and negotiated or closed.
2Naviguard data January 2021 – October 2022. 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 through October 2022. 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.
NO SURPRISES ACT
Here’s what you need to know.
On January 1, 2022, the No Surprises Act (NSA) went into effect. Effective for members when their health plan year commences 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.
What the NSA covers
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.
What the NSA doesn’t cover
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.
Our resources
Resources to get you started.
Use these helpful resources when helping your employees with their out-of-network billing questions and issues.
Out-Of-Network Healthcare Deductibles, Copays, Coinsurance
Deductible, copay, and coinsurance are common terms in health care – but what do they really mean? And how do they affect you?
Learn More
Overview of the No Surprises Act
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
What is Out-Of-Network Billing?
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 MoreContact Us
We’re here for you.
Have a question for Naviguard or want to learn more about our out-of-network medical bill services?