Customer Information Solutions in Health Insurance (Part 1)

Biggest gap in current Health Insurance Solutions is lack of clarity of what is covered by the policy compared to the healthcare cost. This gap is manifested at the time of claim through rejections or delayed/partial service delivery and results in deep consumer dissatisfaction.

(This is a series of posts starting with "Customers don't need Health Insurance!")

This article will focus on first two of the five elements that are key enablers for customers:

1. What does my policy cover/ not cover?

2. How do I use (or activate) my policy cover?

3. How is my personal and medical information used/ how does it help me?

4. Will my health insurance policy help me to...?

5. Will my Health insurance still be "enough" as my health needs change over time?

In a short article it is difficult to describe every element in detail, however for each of these I will share those principles which, in my experience, create maximum value for the customer.

ONE - What does my policy cover/ not cover? From Lists to Personalised Estimates:

Every health insurance product "includes" some coverage while "excluding" others. Usually these are represented in a combination of lists and charts. Problem is, the customer never just spends a night at the hospital or just sees a doctor or just gets a prescription.

• Provide "Cost Estimate" for the Common Services & Events

• Develop digital tools to deliver "transparency resources", e.g. most utilised providers for your condition; providers with high or low readmission for your condition; cost of services across providers for your condition, etc.

• Transparency resources to also indicate how choice among different options will change the Cost Estimate, e.g. Provider 1 will have X% lower price compared to Provider 2; Open Surgery procedure will be Y% higher price compared to Minimally Invasive procedure, etc.

• Attempt to integrate customer feedback on provider service

UnitedHealthcare's "Cost Estimator" tool and transparency resources are evidence of both the implementation as well as the benefit whereby "users" regularly chose higher quality providers and incur lower cost compared to "non-users".

TWO - How do I use (or activate) my policy cover? From filling forms to connected networks:

(A perspective to this was also covered in "Health Insurance Claims")

Claims Processes for health insurance are typically complex, require significant customer input and take time. From a customer's perspective this is a distraction from their medical treatment. Key is direct engagement with the Care Providers and focus on regular customer updates.

• Focus on Cashless Networks linked to your product with tools for easy location & appointment

• Enable active Disease Monitoring and offer digital Records Management & Care Coordination

• Integrate Automated Claims Decision Platform to create efficiency and speed

• Create a trained medical team for active Case Management for high cost/complexity cases

• Provide regular Status Updates to the customer & care provider

Claims Solutions can be complex and interconnectivity between several separate platforms is key to success. Organisations like AXA and BUPA are leading the work as they focus on developing Network Partnerships with Care Providers

THREE - How is my personal and medical information used/ how does it help me?

(to be continued soon in Part 2)

#Technology #Claims #Customer