General information and resources
How it works
Member success stories
• Employees enrolled in the medical plan and their covered dependents (spouse/domestic partner, children)
• Navigating the health care system can be confusing
• It can be difficult to find the right in-network provider or facility for a health need
• Understanding a recent diagnosis can be challenging and overwhelming
• Health Navigator services are available at no cost to plan members and their covered dependents
• We work quickly to connect members with the right specialists
• Our services are completely confidential
Putting our expertise to work for your members
A muti-disciplinary team of experts who collaborate to support our members
Broad relationships with facilities and physicians across the country
Solutions
MD, PhD and specialized medical researchers
20
100
Care Advisors (MDs, NDs, RNs, BSNs, MSWs)
Medical Directors
8
Medical Advisory Board members
75
Relationships at top regional and national hospital systems
130+
In-depth knowledge of both regional specialists and national COEs
Identified and qualified providers
50,000
Centers of Excellences contracted to provide remote written opinions
27
4500+
Experts contracted to provide direct-to-patient video consultations
Identified and provided provider recommendations
30K
When to contact Health Navigator
• Find the right doctor for the member’s specific situation—from primary care providers to specialists and mental health professionals
• Schedule appointments
• Obtain an expert medical opinion
• Help members understand medical conditions and treatment options
• Answer medical questions or prepare for an upcoming appointment
• Gather, organize, and review medical records
What members get with Health Navigator
Support
Access
Collaborative-member focused approach
Members work with trained Care Advisors to help guide them through the complicated healthcare process. Our medical advisors are supported by medical teams.
Getting appointments with top experts and institutions can be challenging- but our team can help get members in-person or virtual meetings—fast.
Advocacy is based on your individual situation and unique needs. Our advisors will support members through their experience to help reach the best possible outcome.
How it works
Gather and review medical records
Identify and connect with the right experts
Facilitate appointments on patients' behalf
Engage top experts remotely
Identify and connect with the right experts
Facilitate appointments on patients' behalf
Engage top experts remotely
• Verify a diagnosis and whether the member has the right provider for their situation
• Review the member’s treatment plan
• When necessary, recommend second opinions, providers, or treatment plans for a diagnosis
Gather and review medical records
• Our research team performs each search with the member’s specific clinical and personal requirements in mind
• We verify the insurance and that they are accepting new patients
• Expedite medical appointments
• Organize and provide medical records to doctor
• Educate patient on diagnosis
• Coordinate care across multiple specialties
• Access to leading experts for serious conditions
• Expertise from across the country delivered to the local environment for care
• Find our dedicated contacts at top national and regional hospitals here.
Efficient—we know members need trusted answers quickly
Seamless and smooth—we are here to make things easier
Objective—we are not part of your health insurance or health system, we explore treatment plans and options that are solely based on what is best for the member
Designed to give members peace of mind—every physician recommendation given to a member is reviewed by one of our medical directors
Improving the member experience—resulting in improved health outcomes
Health Navigator process and timeline
Success Stories
Situation
A 53-year-old male was diagnosed with neuroendocrine tumor of the pancreas. The patient returned to his oncologist for right upper quadrant pain. He underwent a biopsy and repeat PET scan, which revealed benign thyroid tissue and uptake within the lymph nodes and elevated chromogranin. He was referred to a radiation oncologist, who recommended radiation therapy.
How we helped
Collected and reviewed the patient’s medical records
Suggested that the patient seek an expert option at a top Center of Excellence (COE)
Reached out to the COE dedicated contacts, and the patient was seen by a top medical oncologist with expertise in neuroendocrine tumors
Outcome
The specialist confirmed the diagnosis, however, radiation treatment was not recommended since there was no evidence of metastatic disease found. Instead, he recommended the patient enter into an active surveillance program with repeat CT imaging in 6 months.
Avoided Treatment: Radiation Therapy
Minimum price
$582
Fair price
$727
Physician services: procedure fee, intensity modulated radiation therapy (IMRT)
$727
Maximum price
$1,818+
Total cost avoided (based on 25 treatments, average for original diagnosis)
$18,175
Maximum costs based on Healthcare Blue Book Analysis
Situation
A 63-year-old female was diagnosed with right lumbar radiculitis and spondylolisthesis and had been experiencing increased back pain that caused an inability to complete daily activities. She was prescribed medications Lycria and Tramadol by her local pain management specialist. She was seen by a local orthopedic surgeon who recommended a decompressive Transforaminal Interbody Lumbar Fusion (TLIF).
How we helped
Collected and reviewed the patient’s medical records
Suggested that the patient seek an expert option at a top Center of Excellence (COE)
Reached out to the COE dedicated contacts, and the patient was seen by a top spine specialist
Outcome
The specialist confirmed the diagnosis and medical regimen, however, the specialist did not recommend a decompressive TLIF. Instead, an alternative treatment option of epidural steroid injection and a referral to physical therapy was provided.
Avoided Treatment: Decompressive TLIF
Minimum price
$49,952
Fair price
Maximum costs based on Healthcare Blue Book Analysis
$62,439
Facility services
$56,770
Physician services
$3,354
Anesthesia
$2,315
Maximum price
$156,098+
Total cost avoided
$62,439
Health Navigator process and timeline
Additional resources for your employees
Situation
A 54-year-old male from Robbinsville, NJ had fallen on his shoulder several years ago and had been experiencing progressive symptoms over the last several months. He consulted a local orthopedist who diagnosed him with grade 3 AC joint separation and a partial rotator cuff tear of his left shoulder. It was recommended that the patient undergo a rotator cuff repair. The patient contacted Health Navigator initially to confirm his physician was the best doctor to perform the surgery.
How we helped
Collected and reviewed the patient’s medical records
Suggested that the patient seek a shoulder expert at a top Center of Excellence (COE)
An appointment with a top shoulder expert was arranged within 3 weeks.
Outcome
The specialist concluded that the
patient was experiencing a grade 5 AC
joint separation, but that surgery was still
not indicated at the time. Instead, he recommended supervised physical therapy to strengthen his scapular and rotator musculature.
Avoided Treatment: Rotator Cuff Repair
Minimum price
$7,622
Fair price
$11,624
Facility services: outpatient procedure; overnight stay not included.
$8,741
Maximum price
$31,472+
Total cost avoided
$11,624
Maximum costs based on Healthcare Blue Book Analysis
Physician services: Physician fee, repair of shoulder rotator cuff using endoscope.
$1,916
Anesthesia: average price for a 2 hour and 15-minute surgery.
$967
Introducing Health Navigator, powered by PinnacleCare
Continue reading for Health Navigator benefit information, employee resources and more.
Member engagement initiatives
Member engagement initiatives
Health Navigator HR materials
Quick Reference
Benefit Guide Presentation
Health Navigator member materials
Benefit Guide
Contact Card Flyer
Member Digital Experience
General information and resources
Select a topic
What is covered:
Benefit overview
Resources to help your employees
Contacting
Health Navigator
The member experience
Why it's important:
We are here to help:
Our process is:
Additional resources for your employees
Personalized engagement strategy
Shoulder pain
Lumbar radiculitis
Neuroendocrine tumor
Day 1
Day 10
Blue: the beginning and end of the journey
Green: everything handled by the Advisor
Purple: the other departments/teams at PinnacleCare & Health Navigator – research, records, etc.
Orange: clinical/Physician
Member referral
Care advisor consultation
Medical records collection
Medical Director outlines navigation plan
In-person appointment
Appointment facilitation
Research
Educational reports on diagnosis & treatment options
Specialist identification
Remote consultation
Additional needs identified
Follow-up
Verified outcomes member survey ROI Reporting
Getting Started with Direct-to-Employee Engagement
Member FAQs
Navigating healthcare can be difficult and time consuming—but with Health Navigator it doesn’t have to be. Your Health Navigator, powered by PinnacleCare benefit offers your covered employees access to advisors who will support them through any healthcare challenge that they are facing. Whether it is help getting an appointment, assistance acquiring treatment confirmation, or support through a new diagnosis—our team is here for you.
Data science and analytics team
Dedicated Behavioral Health researchers
20
Academic Medical Centers contracted to provide remote written opinions
4,500+
Experts contracted to provide direct-to-member virtual expert medical opinions
• Make informed decisions to help you achieve the best health outcomecare
A collaborative, member-focused approach
collaborative care
Our global relationships with top physicians and hospitals provide members access to the best care.
Our medical directors and clinical team provide members with a deep expertise on a range of conditions and knowledge of the healthcare system.
Our Care Advisors work closely with members to provide ongoing guidance and support.
The expert Health Navigator team works collaboratively to deliver member-focused care.
Ocular trauma
Situation
A 63-year-old female was diagnosed with right lumbar radiculitis and spondylolisthesis and had been experiencing increased back pain that caused an inability to complete daily activities. She was prescribed medications Lycria and Tramadol by her local pain management specialist. She was seen by a local orthopedic surgeon who recommended a decompressive Transforaminal Interbody Lumbar Fusion (TLIF).
How we helped
Collected and reviewed the patient’s medical records
Suggested that the patient seek an expert option at a top Center of Excellence (COE)
Reached out to the COE dedicated contacts, and the patient was seen by a top spine specialist
Outcome
The specialist confirmed the diagnosis and medical regimen, however, the specialist did not recommended a decompressive TLIF. Instead, an alternative treatment option of epidural steroid injection and a referral to physical therapy was provided.
Avoided Treatment: Decompressive TLIF
Minimum price
$49,952
Fair price
$62,439
Facility services
$56,770
Physician services
$3,354
Anesthesia
$2,315
Maximum price
$156,098+
Total cost avoided
$62,439
Maximum costs based on Healthcare Blue Book Analysis
- Joyce, Health Navigator Member
“The worst part is when you don't know what to do. When you don't know how to help your child. And so I called Health Navigator."
FAQs
Health Navigator Monthly Newsletter
Sun Life Health 360
Supporting our clients and members through ongoing information to drive awareness and utilization.
• Relevant health content - Health information directly to your members’ inbox each month from our Medical Directors ranging from lifestyle and general health information to content about specific health conditions.
• Increasing awareness and utilization – People don’t typically think about their benefits until the need them. By keeping Health Navigator top of mind each month, we’re able to increase utilization.
Providing a digital front door to health and wellness support through Sun Life Health 360 for your members.
• Direct access to a Health Navigator Care Advisor
• Self-led mental health support and educational content
• An expansive library providing members with physician-reviewed health and wellness information
• Preventive health support to promote healthier living through daily habits
• Fitness content, meditations, challenges, and tracking capabilities to support a healthy lifestyle
Click here or on the phone to see Sun Life Health 360 in action!
PinnacleCare is a member of the Sun Life Financial Inc. (“Sun Life”) family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of your medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.
© 2024 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada.
Visit us at www.sunlife.com/us.
GSLCR-10712
#1327173751 03/24 (exp 03/26)