Client Service Options

Many insurance plans are complex and confusing, and the policies are difficult to read and understand. Then, you may be faced with the tedious task of handling health insurance claims. Every situation is unique and we are here to support you.

*Please note: Healthcare Pathfinder does not sell insurance or endorse any insurance companies or products.

Consultation Path

Consult on current and future healthcare coverage (e.g. company options, moving, COBRA, divorce, loss of family member, relocation, retiring, Medicare eligibility, children aging off parents plan).
Review and discuss health and long term care insurance coverage and care needs
Identify issues related to current or future coverage

Example: Joe, 63, is retiring from his job. He will not be eligible for Medicare for another two years. In the meantime, he needs advice on his healthcare options until he turns 65 and becomes eligible for Medicare. He also wants to understand what he must do to enroll in Medicare when the time comes. HCPathfinder helps Joe find and enroll in an individual health plan less expensive than the COBRA alternative, and prepares him for when he is eligible for Medicare.

Example: Lisa, 54, was in the middle of a divorce and worried about losing the excellent health insurance she had through her husband’s employer. Concerned about future coverage and costs, her divorce attorney referred her to Healthcare Pathfinder (HCP). HCP provided a comprehensive analysis comparing her current plan to future options, helping Lisa understand how critical this information could be during settlement negotiations.

They reviewed potential next steps, including COBRA continuation, state marketplace plans, and Medicare when she turns 65. They also discussed long-term care planning and anticipated out-of-pocket medical costs. HCP created a detailed comparison of benefits and projected expenses, which Lisa shared with her attorney and financial advisor to help plan for both her immediate and long-term needs.

Insurance Transition Path

Example: In April 2019, Sidney, 41, was suddenly widowed and left to care for her three young children. Overwhelmed and unsure how to secure health insurance for her family, she contacted Healthcare Pathfinder (HCP) on the advice of her financial advisor. HCP reviewed her late husband’s employer benefits through COBRA, assessed marketplace options and subsidy eligibility, and evaluated provider networks—many of which did not include the family’s current doctors. After comparing costs and coverage, HCP recommended COBRA due to its strong benefits, with the flexibility to switch plans during open enrollment. With guidance from HCP and support from her advisor, Sidney chose to stay on COBRA, ensuring continuous, reliable coverage during a challenging time.

Example: Walter and Anne are both turning 65 and want help understanding Medicare and signing up for coverage. HCPathfinder helps them enroll in Medicare Part A & B. HCPathfinder also researches, finds, and enrolls them in a Part D, prescription drug, plan and a Medicare Supplement plan that is the best and most cost effective for their medical needs. HCPathfinder makes sure they receive their new ID cards and then they continue employing HCPathfinder on the Pathfinder Path*.

Project Management Path

Manage claims and provider invoices
Activate and manage long-term care claims
Appeal denied services and claims
Collaborate with medical providers and professional advisors
Provide case management advice and advocacy

Example: Jeff’s wife, Betty, had a major accident that resulted in many insurance claims and bills. Jeff needs help managing the claims, the provider bills, and submitting claims for out of network care. HCPathfinder manages the insurance paperwork and provides healthcare and health insurance support so that Jeff can focus on caring for his wife. After Betty recovered, they took the Pathfinder Path* for ongoing management and support of their healthcare needs.

Example: Anne and John, a couple in their seventies, faced new challenges after Anne broke her hip and needed help with daily tasks. Unsure if their Long Term Care (LTC) insurance would cover private aides or a possible move to Assisted Living, they turned to Healthcare Pathfinder (HCP). HCP reviewed their policies, confirmed coverage for both home aides and AL, and managed the claims process. After three months, Anne met her policy’s deductible, and insurance began paying. HCP continues to handle their LTC claims and healthcare needs, giving Anne and John peace of mind as they enjoy their retirement.

Example: Bill went to the Cleveland Clinic in Arizona for treatment because his insurance card indicated that his plan was part of a national healthcare network. His insurance company denied the treatment saying that his company no longer had access to the national network. HCPathfinder successfully appeals the denial and Bob’s treatment is covered by his insurance company because they failed to properly notify him that his coverage had changed. HCPathfinder saved Bill $15,000 and allowed him access to the care he needed.

Example: Jane lives in Connecticut. Her father, Bill, who lives in Florida, fell and broke his pelvis and couldn’t go home from the hospital. Her family needed someone to help them understand Bill’s discharge options and insurance coverage. HCPathfinder was able to work with the hospital care management team and billing department to make sure that Bill received the care he needed and deserved, had a safe discharge plan, and his Medicare and retiree benefits were understood and maximized.

Example: Jean is in a skilled nursing facility (SNF) after she had hip surgery because she has two sets of stairs in her home and was unable to navigate her home safely. The discharge planner tells Jean and her family that she will be discharged in two days; however, Jean is still having trouble climbing stairs. HCPathfinder advocates on Jean’s behalf and works with the care management team. Jean gets approval to stay at the SNF for another week and a safe plan is developed for her go home.

Elite Client Path

Dedicated Client Services that provide priority professional and administrative support. For clients who want a dedicated advisor and advocate to proactively manage their health and long-term care insurance coverage and care needs.
Core Services include:
Ongoing advice, advocacy, and management support for insurance coverage, claims, medical bills, and care requirements
Annual review of coverage during the Open Enrollment Period to ensure the best plan for our clients' needs
Confidential information is stored in our HIPAA-compliant client management system. This includes the following:

Relevant legal documents (such as Power of Attorney, Advance Directives, conservatorship, etc)
Emergency contact information
Insurance coverage documents
Preferred medical providers
Prescription details and preferred pharmacy
Login information for all insurance or coverage-related websites to allow us to access your information 24/7
Release of information authorization forms on file with all insurance companies and your medical and professional advisors
Access to vetted resources for professional advisors and healthcare services

Example: Walter & Anne sign up for these services after HCPathfinder helped them enroll in new insurance plans. After the enrollments, HCPathfinder keeps all of their insurance information on file so that HCPathinder is available to help them with any problems or questions they have with their healthcare and/or health insurance. In the future, they enjoy having a professional to call who knows their coverage and can help them if they have any questions or problems. Their children also have HCPathfinder available to help them if they need assistance managing their parent’s healthcare and insurance or their own.

Example: Jeff & Betty sign up the entire family for these services to maintain an ongoing relationship due to their complex healthcare needs and large volume of insurance bills and claims. They rely on HCPathfinder to manage all of their healthcare and health insurance needs. Throughout the year, claims are filed with insurance companies and are questioned, negotiated or disputed if necessary. If requested, end of year statements are created for accounting purposes.