What is a healthcare navigator and how can they help?

Healthcare can be hard to navigate. A dedicated health guide can help those unfamiliar with the ins and outs of the healthcare system get the best care.

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The healthcare system can be complex, especially for lay people with no background in the medical field. Too often, people do not know where to go, how to proceed, or what kind of treatment to get when experiencing a healthcare issue.

Despite efforts to increase public knowledge, many people still have a hard time accessing the healthcare system, which can be due to several factors, like:

  • Lack of information, experience, and knowledge in health-related information.

  • Distrust in healthcare providers.

  • An inaccessible healthcare system.

  • No health insurance or medical coverage.

  • False perception about healthcare.

But with the help of a healthcare guide, patients, companies, and employers can easily navigate the health system without barriers. Health navigators, often called health guides, can help address patient hindrances and accompany patients every step of the way.

However, not many people are familiar with what a navigator does. Below, we outlinewhat a healthcare navigator is, their importance, and how healthcare navigation can be a benefits to an organization.

Healthcare Navigators: What is their Role?

Have you ever felt at a loss with what to do after you get diagnosed with a disease? The obvious course of action would be to trust and follow what your doctor told you, right? But what if you didn't fully understand?

When you are experiencing a health-related crossroad, the best thing to do is seek a healthcare navigator's help.

A healthcare navigator refers to a skilled individual or organization who aims to help patients, small businesses, employers, and employees navigate the healthcare system.

Healthcare navigators can render their services in either of these two niches: the health payer space or clinical space.

1. The Health Payer Space
Health payers refer to companies that pay a set amount to healthcare providers for their medical services. This includes insurance companies, third-party health insurance administrators, or government medical programs.

Healthcare navigators can usually be found in the health payer space. Their role in it includes:

  • Help payers look for eligible medical coverages for their employees and complete enrollment and eligibility forms needed.

  • Explaining health insurance plans to purchasers and beneficiaries.

  • Looking for the best insurance package for the payer's purchasers and their beneficiaries.

  • Guides consumers and beneficiaries throughout the whole process of acquiring a health
    insurance plan (e.g., documentation, paper application, explaining its pros and cons)


2. The Clinical Space or Setting
Although a bit uncommon, healthcare navigators can also be found in the clinical or hospital setting. They aim to help patients navigate the maze that is the healthcare system. Some of their specific roles in the clinical space include:

  • Assist patients in finding the right treatment and going through with all of it (i.e.,screening, diagnosis, treatment, and follow-up check-up).

  • Help patients understand their illnesses or diagnosis so they can make sound decisions regarding their health.

  • Explain to them their healthcare packages or plans.

  • Help patients come to terms with their illness and offer emotional support throughout their whole treatment.

  • Help patients find, communicate, and voice out their concerns with their healthcare providers.

Healthcare navigators can be nurses, doctors, or other healthcare professionals. They can also be highly trained individuals who understand the ins and outs of the healthcare system, like billing codes, on-site and off-site facilities, and how to find top-quality doctors.

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