Naviguard negotiates out-of-network balance bills, and the LGBTQ+ resources combine advocacy with plan benefits that vary.
Two different services share a card. Naviguard helps members with bills from out-of-network providers, and the LGBTQ+ resources pair trained advocates with benefits that depend on the employer’s plan.
What the program is and what members do.
What Naviguard does
UnitedHealthcare describes Naviguard as a service that helps reduce what a member may owe for out-of-network care. A balance bill is the difference between the provider’s charge and what the plan allows, and UnitedHealthcare’s example is a $2,000 charge, a $750 plan allowance and a $1,250 bill. Naviguard reviews the case and negotiates with the provider when needed.
How members use it
Members call the number on their ID card to activate Naviguard, tell the representative they have a balance bill, then create a secure online account, upload the bill and answer questions. A dedicated advisor handles the case. UnitedHealthcare says it takes 30 to 45 days on average for a member-initiated case, and that eligible claims are noted in the member account.
LGBTQ+ resources
UnitedHealthcare Advocates are trained with the National LGBTQIA+ Health Education Center and help with benefit questions, finding or scheduling network providers and claims. Members can filter provider searches for LGBTQ Supportive doctors. UnitedHealthcare also lists HIV prevention and services, behavioral health, family formation and gender-affirming care, with prior authorization on many services.
Eligibility, funding and plan design.
Who can use it
UnitedHealthcare says Naviguard is available to members with qualifying employer-sponsored plans at no additional cost. For the LGBTQ+ benefits, it says they are available to members with plans through work and eligible dependents such as spouses, domestic partners and children, and that all plans may not offer every service listed.
How it is funded
UnitedHealthcare says Naviguard services are available to members in participating health plans at no additional cost and are part of the benefits provided by their employer. The pages reviewed do not say what the employer pays, how it is built into the rates or how it differs between fully insured and self-funded groups. That should come from the proposal.
Where it fits in plan design
Naviguard helps after a balance bill arrives. Network design and out-of-network benefits determine how often that happens, so it is a backstop, not a substitute for a good network. UnitedHealthcare cautions that bill reduction success varies and is not guaranteed. The inclusion benefits depend on what the plan document covers and excludes.
What to settle before relying on it.
Is Naviguard active on our plan, and who keeps the savings?
Ask which claims qualify, whether it applies to both fully insured and self-funded groups, and whether a negotiated reduction lowers only what the member owes or also lowers what the plan pays. The answer changes whether the employer sees any benefit at renewal, beyond happier employees.
What do the Naviguard figures include?
UnitedHealthcare reports an average reduction of about $2,600 per case, a 73% average reduction off out-of-network billed charges and more than 1.4 million cases, for January 2021 to April 2025. The 73% is measured against billed charges, and the case count includes closed cases and education. Ask how many were actually negotiated.
What does our plan document actually cover?
UnitedHealthcare says all plans may not offer every inclusion service listed and that many require prior authorization. Get the exact covered services, exclusions, prior authorization rules and dependent eligibility from the plan documents, not from the marketing page. We would have counsel review any exclusion before the employer describes the benefit to staff.
Common questions about this program.
Does Naviguard cost members anything?
UnitedHealthcare says Naviguard services are available at no additional cost to members in participating health plans. Whether the group’s plan participates should be confirmed with the carrier.
How long does a Naviguard case take?
UnitedHealthcare says it takes 30 to 45 days on average to negotiate a case a member starts. It also says bill reduction success varies and is not a guarantee of future results.
Do all UnitedHealthcare employer plans cover gender-affirming care and HIV services?
No. UnitedHealthcare says all plans may not offer some of the services it lists, and that many require prior authorization. The plan documents and the member account show what the group’s plan covers.
Programs and vendors named on this page
Official pages for the services mentioned above. Availability, cost and eligibility vary by plan and employer group, so confirm what applies to your group with the carrier.
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