The 'Edge Report Blog

Health Plans Must Communicate Differently With Members - Part I

September 28, 2016

There is widespread evidence that health plan members are expecting a delightful consumer experience from their health insurers. With the advent of more available choices and the introduction of individual coverage via the exchanges, health plan members are demanding that their experience be at least equivalent to other industries, such as retail, travel and banking.

In a recent survey of 2,500 consumers across the United States, representing all ages, genders and geographic locations, and with a variety of types of health insurance including individual, commercial, Medicare and Medicaid, HealthEdge, in collaboration with Porter Research, found many compelling results that constitute a wake-up call for health plans. A report detailing the full results as well as key takeaways was released today along with the first in a series of infographics that explores the findings in more detail.

Some of the key results indicate that:

Health plans must provide an acceptable level of transparency to their members, or risk dissatisfaction and the potential of competitive disadvantage.

  • 88% of survey respondents across all demographics state that their health plan could be doing a better job of communicating their total financial responsibility. This basic requirement of letting members know what they owe, and how they are doing with deductibles, copays and other financial obligations, is not being fulfilled in the eyes of the consumer
  • 40% of those surveyed reported receiving an unexpected bill for medical services after their insurance had paid their share. And the majority (51%) of those with unexpected bills said that when all was said and done, the bill cost them between $100 and $500.  Another 23% of respondents stated that their out of pocket cost exceeded $500

Health plan’s customer service functions are often challenged to answer simple questions and resolve disputes within a reasonable number of interactions.

  • 27% of survey respondents said they have had a difficult time getting a claim issue resolved with their health insurer
  • Of those, 94% stated that it took at least two phone calls to get the answers to their questions. 22% reported taking more than five phone calls to get to resolution
  • And once a claims dispute is finally resolved, one third of those surveyed said that the outcome was unfavorable to them

There are a number of factors and situations that contribute to consumers’ overall perception of the value delivered by their health plans.  When those consumers have negative experiences, they rate their health plan accordingly.  Some of the key issues cited by survey respondents causing a negative overall value rating were:

  • Difficulty understanding information provided
  • Lack of complete and timely answers to questions posed to the health plan
  • Frustration resolving claims disputes

The repercussions of these key takeaways can be significant, as many members have the ability to switch plans,and a health plan’s reputation and brand is now critical to competitive advantage and the bottom line. Underlying technology can be both a cause of some of these challenges, and a solution to improved member service and satisfaction.  Survey respondents were clear when asked if their confidence in
their insurer’s ability to provide effective coverage and benefits are impacted by the use of outdated technology – 57% said yes. 

This is merely a surface-level look at some of the headlines produced by the survey results. Watch for additional blog posts that take a closer look at the wealth of survey data captured in the State of the Healthcare Consumer Survey.