Stop the shock of out-of-network bills with Naviguard
Naviguard helps employers and members manage out-of-network medical costs through negotiations and transparent pricing protections.
Approximately 1 in 5 Americans have received an unexpected out-of-network medical bill over the last several years.1 Out-of-network medical bills remain a frequent source of employer frustration and employee confusion. Even with strong provider networks and thoughtful plan design, out-of-network charges still occur, creating cost variability and dissatisfaction with health benefits.
Naviguard® is designed to address this gap. Understanding what Naviguard is, how it works and where it fits within an overall benefits strategy may help employers better support employees who may be facing ongoing challenges with out-of-network costs.
What causes an out-of-network balance bill? Under the No Surprises Act (effective Jan. 1, 2022), patients are now protected from most out-of-network balance bills. When care is received at an in-network facility, specialty or ancillary services (such as anesthesiology, radiology, pathology, laboratory or emergency medicine) may be delivered by out-of-network providers. However, these providers are now prohibited from balance billing patients for the difference between what the plan pays and what they charge. Instead, patients are only responsible for in-network cost-sharing amounts (copayments, coinsurance and deductibles). The provider and health plan must resolve payment disputes through an independent dispute resolution process, removing the patient from the middle.
What is Naviguard?
Naviguard is an out-of-network support service offered by UnitedHealthcare that works with certain health plans. Its purpose is to help members understand, manage and resolve out-of-network balance medical bills that might otherwise lead to significant financial stress.
Naviguard combines billing expertise, data analysis and direct provider negotiation to review out-of-network charges and pursue appropriate resolution when bills appear excessive or incorrect. The service can support a wide range of out-of-network scenarios, including specialist services, facility-based care, lab work and ambulance services.
How Naviguard works
Naviguard’s process is designed to be straightforward for members and low-touch for employers:
- Claim review and education
When a member receives an out-of-network bill, Naviguard reviews the claim and helps explain how the charge occurred, what the plan covers and what options may be available. - Dedicated support
Eligible members may work with a dedicated Naviguard advisor who guides them through next steps, including documentation and timelines, and answers questions about their Explanation of Benefits (EOB). - Negotiation and resolution
When appropriate, Naviguard negotiates directly with out-of-network providers using market data and billing expertise to pursue reductions or corrections to billed charges.
Members initiate the process after receiving a balance bill, and Naviguard manages communication with providers, reducing the time and complexity typically associated with resolving out-of-network claims.
Why Naviguard is helpful?
Out-of-network costs are unpredictable by nature and can create financial strain for employees and administrative challenges for employers. Naviguard helps address both sides of the issue by providing:
- Clear explanations of why a bill occurred and what the member may owe
- Expert negotiation to reduce inappropriate or inflated charges
- Administrative relief for employers by handling complex billing issues directly with providers
- Improved member experience through 1-on-1 guidance during a stressful moment
What employers should know
Naviguard serves as a practical complement to network strategy and plan design. Because out-of-network costs can occur even with strong utilization controls, having a service focused specifically on balance bill resolution can help reduce cost volatility and improve employee satisfaction with benefits.
Plus, UnitedHealthcare clients with Naviguard as their out-of-network management program saw even higher savings, with the total cost of care being more than 13% lower than national benchmarks (up to 18% in certain regions) since the program is designed to resolve and reduce out-of-network bills.2
Out-of-network medical bills are an ongoing challenge in employer-sponsored health care, often arising unexpectedly and creating financial and administrative strain. Naviguard provides a structured, expert-led approach to help members understand, manage and resolve these bills. By offering education, claim review and negotiation support, Naviguard helps employers, brokers, consultants and members navigate out-of-network costs with greater confidence and predictability.
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