How to Cancel Your Health Insurance

Please contact Nova Pathfinder Limited directly to cancel your health insurance. * 30 day written notification period – in an effort to serve you better, we have limited the waiting period to the shortest period possible. * Notice in Writing: To protect you, as well as us, we require that the insured give us a notice in writing. Sending an email with a written reason and requested date will suffice. This way both parties have documentation that this is your intent. Include your Name, Address and Policy Number. * Cancel in your portal, or by contacting accounts. After submitting the request, there is a cancellation button in your portal to guide you through the process. Alternatively, you can call us directly and we can walk through this process with you. * After a cancellation request, no further claims will be accepted on the policy. Please contact us directly for further inquiries.

Reimbursement Policy

If you are an active person who uses wellness services and takes supplements to stay healthy, don’t forget to keep your receipts for these services and items. You can submit the expenses in the portal to our claim department and they can be applied to your annual 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. It is important to note that not all supplements and essential oils are equal, nor will all of them be accepted. Check with the member services team to make sure the supplements and oils you wish to buy are approved prior to purchase. Remember that health and wellness service receipts, including visits as well as the purchase of supplements, essential oils, etc. must be submitted within 30 days of service or purchase, and it is the member’s responsibility to validate that the claim department has received those expense receipts. We will confirm via fax or email upon request. Member must request a confirmation via email by contacting claims@mynovahealthcare.org. 

Physicians/Providers or Hospital Claims Types

Any service that requires a prior authorization will not be paid without an approved prior authorization number. All pre-authorization are for allowed amounts that are applied to the deductible allowance 5000/10,000 deductibles, or reimbursed once the deductibles has been met.

Cash prices cannot be negotiated between members and providers. The provider gives the member what they believe to be the self-pay price, but they are overcharged. The term for this is balance billing. Our objectives are to safeguard the members from being overcharged and to negotiate advantageous rates for our members. Members risk losing their insurance coverage.

Claims must be submitted directly to Nova Pathfinder Limited.

Claim Forms:

• CMS-1500
• UB40
• Other specialties

All claims need to be either mailed to:

NOVA Pathfinder Limited HealthCare c/o Claims, 5739 Kanan Road Suite #336, Agoura, CA 91301

Claims can be submitted via the Members Portal

Also, please note that all claims must be submitted within 90 days from the date of service. It is the members responsibility to validate that we have received your claims. We will confirm via Fax or email if request by the member or Physicians/Providers or Hospital. All provider/hospital claims must be submitted within 90 days after the service date that is within your benefit period or the claim will be denied.

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.

Should a dispute arise between you and your Provider regarding his/her charges and allowed reimbursement amount, we will assist in negotiations, should it become necessary, however, in no way will our company be responsible for any charges above our allowed reimbursement amount.          

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 reimbursed.

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 normally consume in order 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 a provider supervision.

If any non-provider receipt is over $100.00 it will need to be prescribed by a provider. 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 the date of purchase. Any receipts received after the 30-day purchase will not be considered.

Also, please note that all receipts must be submitted no later than 30 days from the date of service that is 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 a confirmation via email to claims@mynovahealthcare.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
• Hand written receipts will not be accepted
• In order to be reimbursed or amount apply to deductible allowance the member must provide contact numbers for the store, vendor or provider that they received healthcare services or goods from.
• Bank or credit card statements will NOT be accepted
• Original Paid receipt is required
• All receipts must be clear and legible
• Shipping or taxes will not be applied to allowance or reimbursed
• We will not apply allowance or reimburse for receipts that were paid by points or certificates
• The receipt 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 condition being treated, if available
• Total charges
• Amount paid by Member and how it was paid: cash, check, or credit