Benefit Navigation
Benefit navigation is a critical term for a range of services designed to help clients and their families understand, access, and maximize their healthcare benefits. At HealthSense, we understand that navigating the maze of insurance policies, public programs, and medical bills requires dedicated expertise and persistent advocacy. Our goal is to alleviate this burden, ensuring our clients receive the full coverage they are entitled to while minimizing their out-of-pocket expenses.
Our process begins with a thorough Benefit & Coverage Review, which covers a client’s:
Comprehensive inventory of all health and long-term care insurance policies (e.g., Medicare, Medigap, Medicare Advantage, private insurance, VA benefits)
Analysis of eligibility for public benefits programs (e.g., Medicaid, Medicare Savings Programs, LIS/Extra Help for prescriptions, EPIC, SNAP)
Detailed review of medical bills, claims, and Explanations of Benefits (EOBs) to identify errors and opportunities
Evaluation of prescription drug costs and coverage under current plans (the "donut hole")
Assessment of the client’s unique healthcare needs and financial goals to align with the most cost-effective coverage
Support systems available for financial decision-making and paperwork management
After we’ve completed our evaluation, we’ll develop a comprehensive Benefits Strategy Plan, which will recommend specific steps to optimize coverage, reduce costs, and ensure financial peace of mind. This strategy plan may include:
Specific recommendations for optimizing insurance coverage during Medicare Open Enrollment or other qualifying periods
A clear, actionable roadmap for applying to eligible local, state, and federal benefit programs
Strategies for appealing denied claims for services, medications, or equipment
Guidance on financing both short-term and long-term care needs, including in-home care and facility-based options
Recommendations for Patient Assistance Programs (PAPs) and other resources that can reduce out-of-pocket costs for prescriptions and care
We also can provide assistance in implementing and monitoring the Benefits Strategy Plan, which may include:
Managing and tracking complex medical claims from submission to payment.
Acting as the primary liaison with insurance companies, Medicare, Social Security, and provider billing departments to resolve issues on the client’s behalf.
Assisting with enrollment and disenrollment in Medicare, Medigap, Part D, and Medicare Advantage plans.
Ongoing review of plan effectiveness and cost-efficiency, especially as health needs or plan benefits change.
Resolving complex billing and coding errors that lead to improper charges.
Providing crisis intervention for unexpected coverage denials or catastrophic medical bills.
How It Works:
Book A Consultation
Speak with a dedicated care manager to assess your family’s benefits and insurance needs.
Develop A Benefits Strategy
We create a customized strategy to maximize coverage and minimize healthcare costs.
Ongoing Support & Advocacy
Continuous monitoring and direct intervention with providers and insurers to resolve issues.
"Thank you for enhancing Benny’s (MindSense Client) quality of life so wonderfully. It is amazing knowing he has you there!"
Feel Confident About Your Aging Loved One’s Care
Expert care management and advocacy to help seniors live healthier, safer, and more independent lives.
We help families in the New York metro area take the stress out of senior care. With 30+ years of experience in Aging Life Care™, our nurse care managers guide you through complex medical decisions, coordinate care, and provide personalized support—so your loved one can thrive and you can breathe easier.
We believe aging should be lived with dignity, connection, and purpose. Our mission is to proactively support longer, healthier lives through person-centered care, expert guidance, and comprehensive solutions. By drawing on our diverse team and collaborating with families and care partners, we empower seniors to maximize personal agency, enhance quality of life, and thrive—bringing peace of mind to those who matter most.
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