What is a Patient Navigator (Video in Spanish)

Introduction

A patient navigator is a trained professional who helps you move through the healthcare system with clarity and confidence. Navigators work alongside your clinicians to remove barriers to care, coordinate appointments, arrange transportation, and connect you with community support. If you feel overwhelmed by medical details or insurance rules, a navigator can simplify what comes next and walk with you through it.

This article includes a short video. The message in the video is simple and encouraging. Patient navigators are healthcare professionals who guide people through a complex system so that they can get the right care at the right time. Navigators help schedule appointments, look for transportation, connect you with social groups, and explain treatment options so you can use the benefits available to you. Many people can receive navigation through Medicare and many Medicare Advantage plans when program criteria are met and the services are billed by your clinician using appropriate codes

What a patient navigator does for you

Appointments and scheduling

If keeping track of visits and follow up feels stressful, a navigator helps you organize the schedule, confirm what to bring, and set reminders. Navigators can also prepare you for telehealth visits if you prefer a video call

https://understoodcare.com/care-types/appointments

Preparing for conversations with your clinicians

Navigators help you write down questions, gather past records, and understand how your symptoms and goals should guide each visit. You will feel more prepared and more confident during appointments

https://understoodcare.com/care-types/communication

Understanding treatment options and benefits

Your navigator explains the purpose of tests, medicines, therapies, and referrals in plain language. They can review common side effects, help you consider risks and benefits, and make sure you know what is typically covered by your plan

https://understoodcare.com/care-types/care-coordination

Transportation and logistics

If getting to the clinic is hard, a navigator helps find reliable rides, building access details, and safe mobility routes. For ongoing transportation help, visit https://understoodcare.com/care-types/transportation-help

Community services and social support

A navigator can connect you with meal resources, home safety programs, caregiver support, and local social groups. For caregiver tips, see https://understoodcare.com/healthcare-info/caregiver-support

Insurance and paperwork

Navigators help you gather forms, understand prior authorizations, and share required documents with your care team. They can explain the differences between Medicare, Medicare Advantage, and other plan types so you know how services are approved

https://understoodcare.com/care-types/application-help

Emotional support and communication

Healthcare brings big emotions. Navigators listen, validate what you are feeling, and help you express your preferences to the care team. They can identify when extra support would help, such as counseling or community groups

https://understoodcare.com/care-types/depression‍

How patient navigation works with your care team

Who provides navigation

Patient navigators can be nurses, social workers, community health workers, or other trained professionals. They are part of a team that includes your primary care clinician, specialists, pharmacists, therapists, and community partners

Training and standards

Navigation programs focus on barrier assessment, care coordination, communication skills, and safe handoffs between settings. Many programs use structured tools to track needs and progress so that your plan is organized and consistent

Privacy and respect

Navigators follow privacy laws and share information only with your permission or as allowed by law. You remain in control of your choices. Navigators provide unbiased information to support your decisions

Coverage and costs

Medicare and many Medicare Advantage plans cover navigation services when specific requirements are met. For example, Principal Illness Navigation can support people who live with a serious or high risk condition. Community Health Integration can support people with health related social needs such as food insecurity, housing challenges, or transportation barriers. These services are delivered by trained personnel under the supervision of a Medicare billing clinician. An initiating visit is usually required, and the services must be documented and billed correctly. If you have Medicare Advantage, your plan can cover these services when they meet program rules. If you are unsure about eligibility, a navigator can review your situation and coordinate with your clinician to confirm what is covered

Evidence that navigation helps

Research programs across many health systems show that navigation can shorten the time from an abnormal test to diagnosis, improve the start and completion of treatments, increase patient satisfaction, and reduce missed appointments. Navigation also helps address barriers that lead to inequities in care by linking people to trusted information and community support. These benefits are reported for cancer care and increasingly for other complex and chronic conditions. The consistent theme is practical, person centered help that reduces delays and makes care easier to use

Getting started

Step one set goals

Write one or two goals such as fewer missed appointments, better understanding of a new diagnosis, or safer transportation to care. Share these with your navigator

Step two collect key information

Gather a recent medication list, allergy list, and the names of your clinicians. Bring your insurance card. If you track blood pressure, glucose, weight, or symptoms, bring your notes

Step three prepare questions

Examples include What will this test change, What are common side effects, What is the plan if my symptoms worsen, and When should I call for help

Step four schedule your first navigation session

Ask your primary care clinician or specialist to place a referral for navigation support. If you receive Medicare, ask whether Principal Illness Navigation or Community Health Integration is appropriate for you

How Understood Care can help

Understood Care provides navigation and advocacy services that coordinate appointments, arrange transportation, connect you with mobility equipment suppliers, and help you understand treatment choices and benefits. If you need help with mobility equipment or a home safety review, see https://understoodcare.com/care-types/mobility-equipment. For transportation to and from appointments, visit https://understoodcare.com/care-types/transportation-help. For caregiver guidance, read understoodcare.com/articles/caregiver-support. ‍

Patient Navigators: Frequently Asked Questions

• What is a patient navigator?
  A patient navigator is a trained professional who helps you move through the healthcare system more easily. They work alongside your clinicians to organize appointments, explain tests and treatments in plain language, remove barriers like transportation or paperwork, and connect you with community resources and social support.
• How is a patient navigator different from my doctor?
  Your doctor or nurse practitioner diagnoses conditions, prescribes treatment, and makes medical decisions with you. A navigator does not diagnose or prescribe. Instead, they focus on making the plan easier to follow by coordinating details, explaining options, and making sure you understand and can use the care your clinicians recommend.
• What kinds of things can a navigator help me with day to day?
  A navigator can help schedule and reschedule visits, prepare you for appointments, organize your questions, and send or request records. They can arrange transportation, help with telehealth setup, connect you to meal or home safety programs, and support caregivers. They also help you understand instructions so you know what to do between visits.
• How does a navigator help me prepare for conversations with my clinicians?
  Your navigator works with you to list your top concerns, gather your medication and diagnosis lists, and review what has changed since your last visit. They help you write down clear questions, understand which symptoms are most important to mention, and practice how to describe your goals so your visit time is used well.
• Can a navigator help me understand tests, treatments, and side effects?
  Yes. Navigators explain the purpose of tests, medicines, procedures, and referrals in everyday language. They can review common side effects, help you think through pros and cons, and clarify what should happen next. They do not replace your clinician’s advice but make that advice easier to understand and act on.
• Can a navigator help with transportation and logistics?
  Yes. If getting to the clinic is difficult, a navigator can look up ride options, wheelchair or walker access, parking and entrance details, and any escort requirements after procedures. For ongoing ride support, they can help you use transportation benefits your plan or community programs may provide.
• How do navigators support social and practical needs like food or caregiving?
  When food access, housing, utilities, or caregiving strain make it hard to follow a care plan, a navigator can connect you with local programs such as meal delivery, caregiver support groups, senior centers, home safety services, and social support resources. This kind of help is often part of Community Health Integration for people on Medicare.
• How can a navigator help with insurance and paperwork?
  Navigators help you gather forms, understand prior authorization requirements, and share needed documents with your care team. They can explain the basics of Medicare, Medicare Advantage, and other plan types so you know why some services need approvals and how coverage decisions are made. They may also help you start applications for assistance programs and track deadlines.
• Who provides navigation and how are they trained?
  Patient navigators can be nurses, social workers, community health workers, or other trained professionals. Programs teach them to assess barriers, coordinate care, communicate clearly, and hand off information safely between hospitals, clinics, and community services. Their job is to keep your plan organized and aligned with your goals.
• Will my information stay private if I work with a patient navigator?
  Yes. Navigators follow privacy laws and program rules. They share your information only with your permission or as allowed by law for your care. You can choose who is included in conversations, such as family members, caregivers, or specific clinicians, and you can change those choices at any time.
• Are navigation services covered by Medicare or Medicare Advantage?
  Often yes, when certain requirements are met. Under Medicare, navigation can be covered through services such as Principal Illness Navigation for serious or high risk conditions and Community Health Integration for health related social needs like food, housing, or transportation challenges. These services must be ordered by a clinician, documented, and billed using approved codes. Many Medicare Advantage plans cover the same services when the criteria are met.
• What is Principal Illness Navigation?
  Principal Illness Navigation is a Medicare covered service for people who have a serious, high risk condition expected to last at least three months and that puts them at significant risk of hospitalization or major complications. Examples include cancer, advanced heart or lung disease, serious mental health conditions, and other complex illnesses. Navigation focuses on explaining the plan of care, coordinating multiple clinicians, supporting self advocacy, and connecting you with helpful resources.
• What is Community Health Integration and how is it different from Principal Illness Navigation?
  Community Health Integration focuses on nonmedical barriers that interfere with diagnosis or treatment, such as transportation problems, food insecurity, language or literacy challenges, or unsafe housing. Principal Illness Navigation focuses on guiding care for a specific serious medical condition. Some people receive both services when they have a qualifying condition and significant social barriers, as long as time and activities are documented separately.
• Do I need a referral to get a patient navigator?
  In most cases your primary care clinician or specialist initiates navigation after a visit, especially for Medicare covered navigation like Principal Illness Navigation or Community Health Integration. If you feel you would benefit, you can ask your clinician to refer you and document the condition or barriers that navigation will address.
• How is a patient navigator different from a case manager?
  Both roles coordinate care, but they have different focus points. Navigators concentrate on your experience, barriers, and day to day guidance through the system. Case managers are often employed by health plans or hospitals and focus more on authorizations, coverage rules, and discharge planning. Many people benefit from having both, working together with the rest of the care team.
• Can a navigator attend my appointments with me?
  Yes, when you give permission and the clinic agrees. A navigator may join by phone, video, or in person. They can help you share your priorities, ask questions, take notes, and summarize next steps afterward so you leave with a clear plan.
• How does navigation support emotional health?
  Navigators recognize that healthcare can be stressful, confusing, and emotional. They listen to your concerns, validate what you are feeling, and help you express your preferences to your clinicians. When extra support is needed, such as counseling or caregiver groups, they can connect you with appropriate resources.
• Do navigators replace my doctors or other clinicians?
  No. Navigators do not replace your doctors, nurse practitioners, or specialists. They do not make diagnoses or prescribe treatment. Instead, they make it easier to follow the medical plan you and your clinicians choose by removing obstacles, improving communication, and organizing tasks.
• How do I get started with navigation through Understood Care?
  With Understood Care, you usually start with a clinical welcome call so a doctor or nurse practitioner can understand your needs and goals. After that, you are matched with a care advocate who provides navigation tailored to your situation. Your team then coordinates appointments, transportation, communication with clinicians, benefits questions, and community resources while keeping your preferences at the center of every decision.

References

• Centers for Medicare and Medicaid Services Care Management overview with Principal Illness Navigation and Community Health Integration
  https://www.cms.gov/medicare/payment/fee-schedules/physician/care-management
• Centers for Medicare and Medicaid Services Medicare Physician Fee Schedule final rule summary for calendar year 2024 including new navigation codes
  https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf
• Centers for Medicare and Medicaid Services Health Related Social Needs frequently asked questions covering Community Health Integration and Principal Illness Navigation billing and requirements
  https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
• National Cancer Institute dictionary definition of patient navigator
  https://www.cancer.gov/publications/dictionaries/cancer-terms/def/patient-navigator
• Agency for Healthcare Research and Quality definition and overview of care coordination
  https://www.ahrq.gov/ncepcr/care/coordination.html
• Cleveland Clinic overview of patient navigators and their role on care teams
  https://consultqd.clevelandclinic.org/patient-navigators-at-the-center-of-cancer-care-teams
• Patient navigation in cancer treatment a systematic review of outcomes
  https://pmc.ncbi.nlm.nih.gov/articles/PMC11063100/
• National Cancer Institute Patient Navigation Research Program methods and outcomes
  https://pmc.ncbi.nlm.nih.gov/articles/PMC2698219/
• Timeliness of care improvement with navigation in esophageal cancer
  https://pmc.ncbi.nlm.nih.gov/articles/PMC10243024/
• Effectiveness of system navigation programs linking primary care with community and social services
  https://pmc.ncbi.nlm.nih.gov/articles/PMC10165767/

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.