Please review the circumstances below to determine how to dispute the Point of Service charges in an appeal.
Emergency Care:
If you believe your care was due to an emergency, you may file a claim appeal. Please review the My Nova Healthcare definition of emergency care to determine if an appeal is appropriate.
You contacted your Primary Care Provider (PCP) after the treatment:
This happened because you did not know a referral was needed, the service was a follow-up to preventative care, or you did not realize the referral had expired. As a My Nova Healthcare member, it is your responsibility to be aware of the referral requirements. Point of Service charges cannot be waived if you did not follow the referral requirements. Your PCP/hospital or clinic cannot file a retroactive referral for these circumstances.
Your PCP/hospital or clinic appointment line/referral manager either did not send the referral to My Nova Healthcare or provided you with incorrect information:
My Nova Healthcare advises its members to contact the hospital’s or clinic’s patient advocate to determine if they will submit a referral for services already rendered. If the referral is approved, members can then contact My Nova Healthcare for a claim adjustment. My Nova Healthcare does not have review rights for this situation, and the local hospital or clinic determination is final.
Your PCP did not submit the referral to My Nova Healthcare or the referral was submitted and rejected:
If your PCP gave you a written referral but did not submit a referral to My Nova Healthcare, you may submit a copy of the written referral. If the referral was verbal, you can submit a written statement from the provider indicating when the verbal referral was given.
Submit the documentation with a copy of the Explanation of Benefits (EOB) to:
My Nova Healthcare Claims Correspondence
5739 Kanan Road Suite 336, Agoura, CA 91301
Misinformation from a My Nova Healthcare customer service representative:
If our customer service records indicate misinformation or incomplete information was provided, the Point of Service charges may be adjusted. You may submit a request for review online or via U.S. mail.
Email via secure Encryption I to: claims@mynovahealthcare.org.
U.S. mail: My Nova Healthcare Claims Correspondence
5739 Kanan Road Suite 336, Agoura, CA 91301
Other reasons not listed above: You may submit a request for review online or via U.S. mail.
Email via secure Encryption I to claims@mynovahealthcare.org.
U.S. mail: Nova Pathfinder Healthcare Limited 5739 Kanan Road Suite 336, Agoura, CA 91301