Reimbursement Policy and How it Works
If you are an active person who uses wellness services and takes supplements to stay healthy, save all of your receipts for these services and items. You can send the expenses to Nova Pathfinder’s Claim Department, and they can be applied to your yearly deductible.
Before your deductible has been met, money spent on services such as massages and acupuncture and items like essential oils will count toward your deductible. Once your deductible has been met, you will be reimbursed for future wellness visits and supplements up to the maximum benefit allowance. Remember that health and wellness service receipts, including visits and the purchase of supplements, essential oils, etc., must be submitted within 30 days of service or purchase. It is the Member’s responsibility to validate that Nova’s Claim Department has received those expense receipts. We will confirm via fax or email upon request.
Member must request confirmation via email by emailing: email@example.com.
Physicians/Providers or Hospital Claims Types
- We do not want the Member to pay before the Claims Department calculating the allowed reimbursement. This is so the Member does not overpay.
- If the Member does pay the claim, they must request a claim form for the encounter. The Claims Department will not reimburse the Member based on only a payment receipt with supporting claim forms.
Any service that requires a Pre-authorization will not be paid without an approved Pre-authorization number. All Pre-authorization is for allowed amounts applied to the deductible allowance of $5000/$10,000 deductibles or reimbursed once the deductibles have been met.
Claims must be submitted directly to Nova.
- Other specialties
Receipts (not Claims)
Please follow our policy for submitting receipts, or the amount on the receipt will not be applied to deductible allowance ($5000/$10,000) or once the deductible has been met for reimbursement.
How does the reimbursement qualify?
Non-traditional healing treatments and medicines provided by any professional may be eligible if prescribed to treat a specific medical condition; we look at these very closely.
The treatments must be legal or pre-approved and may not qualify if the remedy is a food or a substitute for food that the Member would typically consume to meet nutritional requirements. On-itemized [bulk or bundled] bills will be Rejected as Incomplete.
*See lists of approved products or services that are covered under receipt submission.
All Health and Wellness Services fall under the provider’s supervision.
Suppose any non-provider receipt is over $100. In that case, a provider will need to be prescribed if it is not in the Approved Products List, even though it is available without a prescription or letter of medical necessity. Receipts for Health and Wellness, Supplements, Oils, etc., will only be accepted if the receipts are within 30 days from the purchase date. Any receipts received after the 30-day purchase will not be considered.
Please note that all receipts must be submitted no later than 30 days from the date of service within your benefit period or plan end date. It is the members’ responsibility to validate that we have received your receipts. We will confirm via fax or email upon request. Member must request confirmation via email to firstname.lastname@example.org.
Appeals must be filed 30 days from the decision date.
For more information, please refer to our appeals policy or dispute a provider charge policy.
The Member will be reimbursed based on the allowed amount and only after the deductible for their policy has been met.
- All receipts that are submitted must be verifiable by the claims department
- Handwritten receipts will not be accepted
- To be reimbursed or amount applies to deductible allowance, the Member must provide contact numbers for the store, vendor, or provider to receive healthcare services or goods.
- Bank or credit card statements will not be accepted
- An original Paid receipt is required
- All receipts must be clear and legible
- Shipping or taxes will not be applied to the allowance or reimbursed
- We will not apply for allowance or reimburse for receipts that were paid by points or certificates
- The ticket must include the Member’s/dependent’s name on the account/receipts to which the allowance is applied
- If the item was paid using an HSA account
- It will be considered a non-reimbursable item.
Example Items to be Included on Receipts:
- Store company and or Providers name, address, and phone
- Member/Spouse/Dependent address and ID number
- Member/Spouse/Dependent name as it appears on our membership roles
- Any Procedure description and CPT code amount charged per item, if available
- And the related Diagnosis & ICD-10 code for the condition being treated, if available
- Total charges
- Amount paid by Member and how it was paid: cash, check, or credit