Health Insurance Customer Service: It’s a Technology Problem

No one I know enjoys calling customer service centers. Dealing with the people who answer those calls – whether you’re trying to get your cable turned on, your flight changed or your wireless bill explained – has become one of the most frustrating interactions in modern life.

Healthcare consumers and providers experience an especially acute level of this frustration when dealing with insurers – a group that ranks below cable companies in most surveys of customer satisfaction. The customer reps who answer those calls often come across as painfully robotic at best, maddeningly disinterested at worst. And no matter how many times they apologize, it’s hard to believe the people at the call center care about you when they so rarely seem able to provide actual help.

I used to feel the same way. I had no idea what the people at call centers did all day, I just knew they almost never solved my problems. That is, until I visited an insurer’s call center and spent a day with the people who work there. What I found was a room full of smart, earnest people working very hard to help their customers. And what I learned was health insurance doesn’t have a customer service problem, it has a technology problem.

Blinking Cursors and Filing Cabinets

When you call an insurer’s customer service line, the well-meaning folks who pick up have to navigate an incredibly archaic, complex set of systems before they can answer any question you have. A customer rep might have to log into one system to find a provider’s account information, another to look up specific policy details and a third to understand the payer-provider arrangement. And that’s the easy stuff. Questions about procedures that need special authorization or that involve complex agreements with large health systems might trigger expeditions into systems a rep hasn’t accessed for months.

One customer service rep I saw had close to 20 notes on her desk, each with login credentials for different systems. Some of the screens I saw actually had green-text-on-a-black-background, bringing me back 20 years to blinking-cursor-box interfaces.

But just when I thought it couldn’t get more outdated, I saw a rep field a call from a customer who wanted to update the phone number on her account. To make that simple change the rep had to get up, retrieve a form from a file cabinet, fill it out and walk it over to another department, where it was entered into some system the rep couldn’t access from her desk. From there the customer’s new number would be updated – in two days, after the new batch files were uploaded. 

Sitting there watching these people trying to navigate their way through all those antiquated systems – often while dealing with frustrated providers or flustered, emotional patients – reminded me of a crucial fact of life in the healthcare industry: insurance companies aren’t technology companies. So as they’ve encountered new requirements and problems over the years, they’ve often turned to various outside providers for discrete solutions. And as the healthcare industry has consolidated, acquiring companies have preserved legacy systems of the companies they purchased.

A Simple Solution

I am an engineer, and when I see problems like this I want to solve them. And I believe this one can be solved — with existing technology and a powerful infusion of determination from payers, providers and patients alike.

I’m convinced that most of the problems with insurers’ customer service centers could be solved by bringing disparate data together into a single system, so that reps don’t waste time jumping between systems, trying to guess which one holds the information they’re looking for and logging in and out every time. Payers may have tried to do this in the past on their own, without success. I’m convinced that if we could objectively look at their different systems, bring all their data together and provide a solution that leveraged what they have, they would be able to successfully convert their data into valuable insights and actionable information.

We should also give those reps a better interface to work in. I actually saw a customer rep go to Google to look up information about a provider she had on the phone. Insurers’ interfaces should work like Google’s – with intuitive design and smart workflows that serve up what reps need quickly and suggesting further solutions or options based on previous similar inquiries.

That would save every rep a few trips to their supervisor’s desk to ask for custom solutions. More importantly, it would empower them to solve problems quickly and decisively.

Providers can help get us to solutions like that by impressing upon payers how antiquated call-center systems make the entire industry more costly and inefficient. I saw a customer rep send an insured patient to the emergency room because, after numerous searches through the insurer’s systems and calls with the provider system, nobody could find proper confirmation that the patient was covered at that provider (though her policy said she was).

If we want a health system that functions better, we have to help each other understand the implications of specific problems – and the powerful impact that even simple technology solutions could have.

Jyoti Mokal is Director of CRM Technology for software company, Zipari.

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