Customer communication benefits for health insurers (and members)

Consider this scenario:

Mary signed up for health insurance coverage through her work but she rarely used her benefits. Other than annual enrollment time, her insurance company made no attempt to engage Mary in any conversation or relationship. Why should they? That just costs money the company could use to pay claims of members that really need the benefits.

One night, appendicitis sent Mary to the hospital for unexpected surgery. Recovering at home, she started receiving mail. Bills from her doctor, the hospital, labs, surgeons, anesthesiologists, and radiology arrived quickly following treatment. Most confusing of all, her health insurer sent several documents that seemed to indicate Mary owed money for deductibles, out of network providers, and exceeded coverage limits. The Explanation of Benefits forms said to call Customer Care if she had questions. So she did.

After multiple transfers and over an hour on the phone Mary got her questions answered. The time spent handling the call was expensive for the insurer though. It turned out Mary didn’t need to do anything but wait for more updated information. Her first personal interaction with the insurance company left Mary needlessly stressed and embarrassed for not understanding how it worked.

Crystal clear messaging is paramount to healthy customer relationships. Claim-related documents typically arrive at an already stressful period for the insured because of health concerns, time away from work, or out of pocket expenses. Members don’t deal with insurance issues very often. Incomprehensible documents or an excess of jargon can be a flashpoint if there is no easy way to get more information.

Accessibility, information, relevance

A key factor in the strength of customer relationships is the nature of communications beforethe generation of documents typically responsible for prompting questions or concerns. If little or no connection with members exists, the relationship is weak. Any confusion or perceived problems can spawn distinctly negative conversations.

Using some information they already had about Mary, her health insurer could have sent her some informational material or links to online content about how claims are submitted and paid, explained what happens when someone requires a hospital visit, how to avoid out-of-network charges, etc. They might have suggested some health tips, introduced her to the Ask-a-Nurse program, or explained some of the benefits she wasn’t using.

Other customers might receive information more relevant to them. A health insurer might introduce retirees to senior fitness programs offered in their area or tell them about mail order pharmacies. They might remind parents with school age children to make sports physical appointments or help them accumulate immunization records before school starts, etc.

All these “non-essential” communications help create a foundational relationship while establishing loyalty and tolerance for issues that might occur later. Educational content sets reasonable customer expectations. Documents can direct members to online or automated telephone self-help resources. These are much less expensive than customer service representatives handling one caller at a time.

The documents an insurer produces can either enhance or degrade the connections. Delivering periodic informational content relevant to each member is easily accomplished with modern customer communications management software. Contemplating relationships from the customer’s viewpoint is an exercise worthy of periodic examination. Adjusting communications accordingly is a strategy beneficial to both parties.

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