Frequently Asked Questions

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What is navces?

navces is a Patient Advocacy Service created by Doctors to protect our members by exposing the truth about price and quality variation between medical providers. We find you, navces recommended High-Value Medical Providers, at a Fair Price.

What does navces do?

We provide easier access to navces recommended in-network High-Value Medical Providers—while saving you money on needed healthcare services. 

navces is a premium “concierge” service that helps ease the burden of finding navces recommended in-network High-Quality, High-Value Medical Providers at a Fair Price for an eligible medical test (CT scan, MRI scan, PET scan, Ultrasound, etc.), procedure (Colonoscopy, EGD, etc.), surgery, or if you are an expecting mother.

You may be eligible for navces Incentive Rewards for following our professional guidance.

Do I have to pay to use this program?

No. navces is sponsored by your employer as part of your benefits program.

What is a “navces recommended High-Value Medical Provider”?

A navces recommended High-Value Medical Provider includes any doctor, facility, or hospital that offers the highest value in terms of care quality, cost, and access.

Why does navces do this?

We know that choosing the right medical provider for your healthcare needs is challenging. Furthermore, “shopping” for High-Quality at a Fair Price for healthcare is not easy. We see this problem every day and have solved it thousands of times for others.

navces solves this problem by providing a navces Patient Advocate-supported online platform that enables patients to understand price and quality before receiving care. Our trained navces Care Guidance Team uses national data scores and verified quality measurements to save hundreds, even thousands of dollars. 

We will point you in the right direction to receive the best quality care. navces will compare providers for you, on both cost and quality rankings. If you use one of the navces recommended High-Value Medical Providers, you can earn navces Incentive Rewards.

How does navces do this?

navces has over 440 shoppable medical procedures and the quality scores to recommend high-quality, cost-effective providers. 

For example…

Price variance of a Colonoscopy (screening) in Gainesville, FL

*Infographic Data Source Healthcare Bluebook

How does navces determine what is a “Fair Price”?

navces uses a proprietary analytics system to evaluate the allowed amounts (or discounted amounts) from medical claims and pricing in your geographic location and local market. This includes a variety of data sources to provide members with accurate Fair Price information for healthcare services individualized to their needs. This system is used to develop Fair Price data and provide High-Value quality rankings in markets nationally. navces can provide this service to all markets, all locations, and in all states.

Why does navces not provide the exact price for a medical procedure or facility?

navces provides price rankings instead of exact prices because, in some cases, additional services may need to be provided at the time of the appointment, changing the overall cost. 

A patient for example may expect to have an MRI scan without contrast. During the exam, it may be determined that contrast is needed for the MRI study. The actual MRI in this example, with contrast price, will be different from the MRI scan without contrast price. 

However, navces will guide you in choosing a navces recommended in-network High-Quality Medical Provider at a Fair Price so you do not overpay for your medical services.

How does navces assign Hospital quality rankings?

navces uses multiple proprietary data points when determining quality rankings.

While hospitals can perform many different procedures, most hospitals do not have the same level of quality in every clinical area. 

Hospital quality rankings are designed to help patients understand each hospital’s overall level of quality for a particular inpatient clinical area or procedure. Similarly, our physician rankings are designed to help patients understand a physician’s overall quality, as well as the physician’s outcomes for specific procedures. Each hospital is compared against all other US hospitals and each physician against other physicians. Note that most diagnostic testing is not measurable for quality.

How does navces assign Physician quality rankings?

navces quality rankings are built upon the same patient outcomes-based framework as the hospital quality rankings. We offer both overall and procedure-specific physician rankings when available.

Physician quality ranking is calculated with multiple data points by evaluating each physician’s patient-specific outcomes in a clinical area. The ranking is calculated by combining a physician’s performance in several areas: patient complications, patient safety, mortality, and unplanned re-admissions. All metrics are risk and volume adjusted. Calculations are based on a statistically significant sample drawn from CMS data. Our methodology is validated and published in peer-reviewed medical journals.

Are all hospitals good at all things?

No, very few hospitals are good at all things. 

Other quality metrics you will see only use a single overall ranking for each hospital. That does not work effectively in the patient’s best interest. That approach is not helpful to members because a single ranking can mask important differences in the level of quality between clinical areas at the hospital. 

For example, a hospital can be among the highest performing facilities in the US for heart surgery, yet the same hospital can also be among the poorest performing facilities for joint replacement. If you are a patient in need of a knee replacement, you must have the ability to assess the hospital’s performance specifically for the care you need, as opposed to an overall hospital score across all clinical areas. navces uses multiple comprehensive data points in its research for quality rankings.

What is the data source for quality information?

navces uses multiple data points for quality rankings, including hospital and physician quality rankings data from CMS, all-payer databases and the Agency for Healthcare Research and Quality (AHRQ), and Healthcare Bluebook. We also use independent research performed by our navces Care Guidance Team, which is composed of licensed and practicing Physicians, Registered Nurses, and Patient Advocates.

Does a navces quality rank guarantee I will have a positive outcome?

The quality rankings highlight which hospitals and/or physicians have historically demonstrated better patient outcomes for a particular service. The quality score is a reliability score relative to other hospitals/physicians in the US—however, it is not a guarantee.

How does this help me?

You can save hundreds, even thousands of dollars on medical procedures and earn up to $1,500 in navces Incentive Rewards with the navces Incentive Rewards Program.

Why do I get a navces Incentive Reward for seeing a navces recommended in-network High-Quality Medical Provider?

navces has been selected by your employer and is typically accompanied by the navces Incentive Rewards Program as an added benefit to help you with the cost of healthcare services. 

The navces Incentive Rewards Program was created to encourage healthcare consumerism by rewarding plan participants when they make good consumer choices by using cost-effective, high-quality providers. 

You could receive a check because you or one of your dependents recently used a navces recommended in-network High-Value Medical Provider.

How do I know if I am eligible for navces Incentive Rewards?

To see if you are eligible, you MUST contact navces before you seek testing or treatment. You can call 1-(833) 4-navces (462-8237) or email rewards@navces.com.

Can my eligibility for the navces Incentive Rewards expire?

Yes, all eligibility documents for navces Incentive Rewards must be submitted within sixty (60) days from the date of service to be eligible for the rewards.

How does it work?

You may be eligible if you are referred by a Medical Doctor for: 

  1. Any medical service subject to your major medical deductible, including pregnancy 
  2. A major diagnostic service such as CT scan, MRI scan, PET scan, Ultrasound, etc. 
  3. Are referred for an outpatient procedure such as a Colonoscopy, EGD, etc.
  4. Are diagnosed and referred for treatment with inpatient or outpatient surgery

Eligible participating health plan members may be entitled to up to $1500 in navces Incentive Rewards for using a navces recommended High-Value Medical Provider.

How do I receive my navces Incentive Rewards?

navces Incentive Rewards are mailed to your home address and will be addressed to the employee, regardless of which family member received care.

Can I receive multiple navces Incentive Rewards?

Yes. You may receive multiple navces Incentive Rewards for procedures rendered on the same day. For example, a patient may need a Knee MRI scan and a Hip MRI scan on the same day. In this case, the patient would receive a separate reward for using navces recommended High-Value Medical Providers for both of the separate services.

Can I receive navces Incentive Rewards if I am no longer an employee?

You or a family member must be a current employee with active health insurance coverage at the time of navces Incentive Rewards processing to receive the reward. Your employer reserves the right to modify or discontinue the navces Incentive Rewards Program at any time.

What are the steps needed for Employees/Members to get navces Incentive Rewards?

To see if you are eligible, you MUST contact navces before you seek testing or treatment. You can call (833) 4-navces or (833) 462-8237, or email rewards@navces.com.

Step 1. Go to www.mynavces.com, call (833) 4-navces or (833) 462-8237, or email rewards@navces.com. 

Step 2. Your navces Patient Advocate will contact you to confirm what test or procedure is needed and open a navces Care Guidance Ticket.

Step 3. Your navces Patient Advocate will find you navces recommended in-network High-Value Medical Providers focused on quality and cost.

Step 4. You can choose any one of the navces recommended in-network High-Value Medical Providers.*

Step 5. Once completed, members will send (1) their Insurance Explanation of Benefits (EOB) and (2) the Bill from the Provider, Doctor, Facility, and/or Hospital to us at rewards@navces.com. You can also fax it to us at (786) 471-1078.  

Note: All navces Incentive Rewards supporting documents must be submitted to navces within sixty (60) days from the date of service to be eligible.

*Members may choose any provider they wish but must use a navces recommended in-network High-Value Medical Provider to be eligible for the navces Incentive Rewards Program.

How can I get more information about the navces Incentive Rewards Program?

If you have any questions about the navces Incentive Rewards Program, please contact your HR Department, go to www.mynavces.com, call (833) 4-navces or (833) 462-8237, or email rewards@navces.com.

navces is not an insurance company or provider. navces, LLC operates independently of your insurance company and your employer. We do not provide medical advice or treatment. In an emergency, contact 911 or go to the nearest emergency room before calling navces for assistance.