NaviClaim Member Advocates Guide

Detego Health LLC's® Member Advocates are your dedicated support team. They’re there to help you navigate your health benefits plan, answer your questions about coverage, assist with finding in-network providers, and make sure you understand your benefits clearly. 

 They provide direct support whenever you have questions about your coverage, need help finding a provider, or want a clearer understanding of your benefits.

They work closely with healthcare providers to make your care easier by coordinating with doctors, specialists, and medical offices — handling everything from coverage verification to billing support.

They look for ways to reduce your out-of-pocket costs and help you save money, making sure you get the most value from your health benefits.

They assist in finding in-network doctors and providers that fit your needs, considering your location, preferences, and health requirements to ensure you receive the right care.

If you receive a bill for charges you shouldn’t be responsible for, they offer balance bill support — explaining the bill details and, if needed, working directly with the provider to resolve or reduce those charges.

When the best provider for your care is out-of-network, they help initiate Single Case Agreements to try and secure in-network benefit levels for your treatment. Please note, these agreements are not guaranteed.

If you’ve paid out-of-pocket for a covered service, they assist with reimbursement requests by gathering and submitting the necessary forms and information to the processing department.