Your Garner Guide

No. Garner is not your health insurance. It is an additional benefit that complements your health insurance plan by helping you connect with in-network providers who offer quality care, have availability, and deliver optimal patient outcomes. By choosing these Top Providers, you not only ensure top-notch care but also become eligible for reimbursement of qualifying out-of-pocket medical costs.

No. While we encourage you to see Top Providers to ensure you are receiving the best care, you have the choice to receive care from a provider who is not a Top Provider. Out-of-pocket costs from these providers will not qualify for reimbursement.

Your employer or fund cares about your health. In order to help you find the best care, they pay for you to have the Garner benefit. High-quality care lowers healthcare costs—patients who see Top Providers will generally pay less in the long run and be healthier. For example, if you have a smooth recovery, your total cost of care will be lower than if you have complications and need to be hospitalized.

Garner helps your employer or fund pass these savings along to you through an innovative health reimbursement arrangement (HRA)—get paid to see the best doctors and stay healthy. It’s a win-win for everyone involved.

Any dependent covered by your health insurance plan is eligible to use Garner to find Top Providers and can be reimbursed for qualifying out-of-pocket medical costs. Your family only needs one account, but any dependent aged 18 or older is welcome to create their own account.

Reimbursements will be sent to the primary member who holds the health insurance plan.

You can log in to your Garner account and view more details here.

To use the app in Spanish, log into your Garner account and click here to navigate to your account settings. Under the “Language” section, choose “Spanish” from the drop-down menu.

Garner identifies Top Providers by analyzing one of the largest medical claims databases in the U.S.—that’s more than 60 billion medical claims representing more than 320 million patients. They are highlighted in the Garner Health app with a green Top Provider badge and represent the best available doctors near you who are in your network and have appointment availability.

We try our best to recommend Top Providers that are in-network with your health insurance plan. Since insurance companies change their networks regularly, we always recommend verifying with your health plan that a provider is still in-network on or before the day of service.

Find providers by searching by symptom or for your provider’s name and zip code. Providers with a Top Provider badge are eligible for your Garner benefit and are automatically added to your list of approved providers as soon as their Top Provider badge is visible on your screen. The Concierge may also add approved providers to your account. Just remember, all providers must be in-network and your health insurance plan must cover the services you receive for any out-of-pocket costs to be eligible for reimbursement.

To view your approved providers list, please log into your Garner account and navigate to the "Settings" page and select "Approved providers" in the menu.

No. Your list of approved providers carries over each year.

Garner Top Provider rankings can change each month. While a doctor’s quality of care typically doesn't change much month to month, this is to ensure we have the most up to date directory information and new patient availability.

If a member has previously added a Garner Top Provider to their Care Team, any recommendation updates will not affect the doctor’s approved status for that individual member and their dependents.

No. Garner evaluates the performance of individual providers, not entire medical centers or hospitals. Use the Garner Health app to search for specific providers by name to see if they are a Top Provider and approved for your Garner benefit.

Yes. Even if your colleague found the Top Provider through Garner, you must search for that provider using your Garner account and add them to your list of approved providers before you receive care from them. Top Providers are automatically added to your list of approved providers as soon as their Top Provider badge is visible on your screen.

Search for your specialist by entering their name and zip code. If your specialist has a Top Provider badge, qualifying out-of-pocket medical costs from services performed or ordered by that specialist are eligible for reimbursement on or after the date you add them to your list of approved providers. If your specialist is not an approved provider, you can still choose to receive care from them, but those out-of-pocket medical costs will not qualify for reimbursement.

All new providers, including specialists, MUST be Top Providers in order to qualify for the Garner benefit. If you need to find a new provider, use the Garner Health app to find a Top Provider or contact the Concierge for assistance. Specialists must be added to your list of approved providers prior to the date of service in order for out-of-pocket medical costs to qualify for reimbursement. For example, if your PCP recommends that you see a GI specialist for stomach pain, you must check with Garner to ensure the specialist is a Top Provider, and then add them to your list of approved providers before your date of service.

We understand it can be disappointing if your current doctor isn't covered by Garner. Our mission is to help you access high-quality care while reducing your out-of-pocket costs.

How does Garner select Top Providers?

Garner's doctor recommendations are based on real patient outcomes to help you find the best doctors near you. Our recommendations go far beyond patient reviews. We look at billions of claims to understand the specifics of how doctors provide care.

Doctors can't pay to show up in our recommendations. Garner is an objective third party that selects Garner Top Providers based on doctors who:

• Follow current medical guidelines

• Avoid unnecessary procedures

• Charge fair prices for their services

• Help patients recover faster

Garner Top Providers are the best doctors in each specialty and region of the country. Garner always looks for the best doctor option in your region, and accounts for the number of doctors available in your neighborhood.

How does Garner evaluate doctors? We assess each doctor based on specific metrics related to their specialties, such as:

• Complication rate: Measure a doctor's complication rates

• Invasive procedure rate: Determine if a doctor performs more invasive procedures only when necessary given they entail longer recovery times and complication risks

• Follows current medical guidelines: Evaluate if a doctor recommends optimal treatment according to medical guidelines

If your doctor isn't listed as a Top Provider, it doesn't mean they aren't a good provider—it simply means they haven't met Garner's criteria at this time. If you choose to continue seeing your current doctor, we respect your decision. However, please note that visits with non-Top Providers are not eligible for Garner reimbursement.

We encourage you to consider a second opinion from a Garner Top Provider to ensure you're receiving the best possible care. You can always return to the Garner Health app to search for new doctors and get reimbursed for future care that meets eligibility requirements.

If you're currently seeing a provider for a critical or ongoing care need, please reach out to Garner Concierge through the Garner Health app or email us at concierge@getgarner.com.

Garner reimburses qualifying out-of-pocket medical costs that include office visits, lab work, imaging and procedures ordered or administered by your approved providers. To learn if other medical costs qualify for reimbursement, log into your Garner account and navigate to the benefit section.

Your out-of-pocket medical costs will qualify for reimbursement if:

1. You have created a Garner account and added the provider to your list of approved providers prior to the date of service.

2. Your provider is in-network and the cost was covered by your health insurance plan.

3. The type of cost qualifies for reimbursement under your Garner plan.

4. If your health insurance plan is paired with an HSA, you will need to incur costs greater than the minimum deductible.

When a Top Provider orders labs or imaging, these costs automatically qualify for reimbursement if:

1. The Top Provider was on your approved providers list before the date of service.

2. The facility is in-network and the services provided are covered by your health insurance plan.

In this case, you do not have to find the facility in the Garner Health app. If you would like to locate a facility on your own, recommendations for labs and imaging centers can be found in the Garner Health app. Out-of-pocket medical costs at these facilities qualify for reimbursement, when the following conditions are met:

1. You locate the facility in the Garner Health app or website before your date of service.

2. The facility's profile page displayed a yellow banner stating "eligible with some exceptions." This indicates that out-of-pocket medical costs for the service you are seeking at that facility qualifies for reimbursement.

3. The facility is in-network and the services provided are covered by your health insurance plan.

While we strive to ensure recommended facilities are in-network with your health insurance plan, this information is subject to change. We recommend confirming with the facility before your appointment.

Garner does not recommend specific hospitals or facilities beyond those that fulfill the qualifications above. If seeking care at another facility, ensure the provider is a Top Provider in the Garner Health app or website before your appointment to qualify for your reimbursement.

We understand you can’t choose ancillary providers such as anesthesiologists, radiologists and nurses. Your Garner benefit will reimburse all qualifying out-of-pocket medical costs if:

1. The approved provider is added to your list of approved providers prior to your appointment.

2. The approved provider is ordering or is primarily performing the service.

3. The service is in-network with your health insurance plan. To confirm coverage, check the list of services on your health insurance card or call the number on the card. If you have an online account with your health insurance provider, log in to your portal to confirm coverage details.

Garner works with your medical insurance, which generally does not cover dental or vision services. Garner may reimburse qualifying out-of-pocket medical costs for procedures such as oral surgery, but only if the claim for that service is processed by your medical insurance plan.

No. Garner reimbursement occurs after costs are processed by your health insurance plan. Your health insurance plan must cover qualifying medical care and you must submit your out-of-pocket expenses to your insurance company for them to be eligible for reimbursement.

Most of the time, you don't need to do anything—reimbursement is automatic! However, if you have a medical claim over $2,000 or, if your Garner plan has prescription coverage, a prescription claim over $500, you'll get a notification in the Garner app, and the claim will show "more info needed" in the Claims section of the app. Open the claim and tap the button in the banner, then:

1. Enter the amount you paid out of pocket for that visit or prescription.

2. Add a document that shows the amount, if we need one. For a medical claim, any of these works:

   • An Explanation of Benefits from your health plan

   • A bill from your provider showing what you owe

   • A receipt showing what you paid

   • A credit card or bank statement showing the payment

   For a prescription, use a pharmacy receipt showing the prescription and what you paid, or a card or bank statement showing the payment.

3. Submit. We'll review it and update the claim in the app.

A few things worth knowing:

• If you did not pay anything, or you paid with HSA funds, enter $0.

• For prescriptions under $100, entering the amount is usually all we need—no document required.

This helps ensure security and accuracy for larger payments.

When you receive care from an approved provider, pay your upfront costs as usual. Garner has access to your insurance plan’s claims. After your health insurance company processes the claim, Garner will reimburse your qualifying out-of-pocket medical costs.

You have two options for receiving reimbursement: 

1. If you are the primary member you can set up direct deposit for faster and more secure reimbursement. Because the speed that billing departments submit claims to your health insurance company can vary, it typically takes 5-6 weeks to receive reimbursement after the service takes place. Watch this demo video to learn how to set up direct deposit.

2. If you do not set up direct deposit, a reimbursement check in a white envelope will be sent to the mailing address the primary member has on file with their employer, arriving in about 6-8 weeks.

You have two options for receiving reimbursement:

1. If you are the primary member, you can set up direct deposit for faster and more secure reimbursement. You will receive your reimbursement directly to your bank account and faster than a check. Watch this demo video to learn how to set up direct deposit.

2. If you do not set up direct deposit, a reimbursement check in a white envelope will be sent to the mailing address the primary member has on file with their employer.

You can reach out to the Garner Concierge for answers to your reimbursement questions by messaging them.

To learn more about what medical costs qualify for reimbursement, log in to your Garner account and check your coverage details or message the Concierge.

Most of the time, you don't need to do anything—reimbursement is automatic! However, if you have a medical claim over $2,000 or, if your Garner plan has prescription coverage, a prescription claim over $500, you'll get a notification in the Garner app, and the claim will show "more info needed" in the Claims section of the app. Open the claim and tap the button in the banner, then:

1. Enter the amount you paid out of pocket for that visit or prescription.

2. Add a document that shows the amount, if we need one. For a medical claim, any of these works:

   • An Explanation of Benefits from your health plan

   • A bill from your provider showing what you owe

   • A receipt showing what you paid

   • A credit card or bank statement showing the payment

   For a prescription, use a pharmacy receipt showing the prescription and what you paid, or a card or bank statement showing the payment.

3. Submit. We'll review it and update the claim in the app.

A few things worth knowing:

• If you did not pay anything, or you paid with HSA funds, enter $0.

• For prescriptions under $100, entering the amount is usually all we need—no document required.

This helps ensure security and accuracy for larger payments.

For PEBB members, Garner will only reimburse claims covered and processed by the Providence Health Plan or the Moda Health Plan. If you have secondary coverage outside of the Providence or Moda Health plans, Garner will only reimburse eligible out-of-pocket expenses processed by Providence or Moda. Garner does not interact with or take into account any secondary medical plan insurance outside of the Providence or Moda Health plans.

There are several reasons why a claim might not qualify for reimbursement; for example, your provider may not be a Top Provider, or the services may be out-of-network according to your insurance. If you believe your claim was denied in error, here is how to determine what happened and get it resolved:

1. Check the denial reason. View your claim in the app to see exactly why it was denied.

2. Submit additional information. You can upload documents at the bottom of the claim screen directly in the Garner Health app or contact the Garner Concierge for help.

How to reach the Garner Concierge:

• In-app chat

• Email: concierge@getgarner.com

• Phone: (866) 761-9586

• Hours: Monday – Friday, 8:00 a.m. – 10:00 p.m. ET. Se habla español.

We'll take another look. If we made a mistake (such as missing a doctor's NPI in the documents), we will fix it and overturn the denial.

Still denied? If the claim is reviewed and the denial is upheld, but you still disagree with the decision, you can file a formal appeal directly in the Garner Health app.

If you have a health Flexible Spending Account (FSA), special rules apply to your Garner benefit. You may not be reimbursed by the Garner HRA for an out-of-pocket medical cost that will also be paid using your FSA. This is often referred to as double-dipping and is prohibited by the IRS. If your Garner HRA and your FSA cover the same medical cost, we recommend you use and exhaust your Garner funds before using your FSA. You can save your FSA for when your Garner benefit has reached its limit or for out-of-pocket medical costs that do not qualify for reimbursement by Garner, such as dental care.

The Garner Concierge is a group of professionals dedicated to answering your questions and helping you find the best care for you and your family. If you need help finding a Top Provider or have a question about your benefit, you can message the Concierge for assistance.

You can message through the Garner Health mobile app, (458) 488-4828, or by email concierge@getgarner.com. Concierge hours of operations are Mon-Fri 5 a.m. to 7 p.m. PST. Se habla español.