Being a US health insurance customer sucks. Does it have to be this bad?

I have a sick kid. Thankfully it’s not life-threatening, but for the past three-and-a-half years he has been battling an often debilitating neuropsychiatric auto-immune disorder that has severely impacted his education and social life. It has also taken six-figure chunks out of our bank account every year in out-of-pocket medical expenses that insurance companies don’t cover. I share this not for sympathy but for context.

Several months ago, my son’s neurologist recommended a new treatment regimen to add to his current protocol. It’s an antibody therapy that is most often used in combination with chemotherapy to treat cancer patients, but is also used to treat certain autoimmune diseases and the neurologist has had success incorporating it into treatment for my son’s condition. The doctor’s office applied to our health insurer for pre-authorization and we were denied.

We had expected to be denied on the first request and tried to submit an appeal. For the past three months, both the doctor’s office and my wife have called the insurance company multiple times a week, navigating their IVR, and, since no human ever answered the phone, leaving messages indicating that we wished to start an appeal. Finally, last week, we got a service rep on the phone. To make an incredibly frustrating story as short as I can, because we hadn’t previously been able to speak to someone, and, therefore, hadn’t submitted the appeal within two weeks of being denied, we have to start the process all over again. We know it will be denied on what will be a new first appeal, and we have no idea whether we’ll be able to get through to a human being to initiate an appeal within two weeks of that denial.

It’s just one anecdote, but it encapsulates so much of my experience as a health insurance customer. Ultimately, Health insurers suck at CX (customer experience). If I tried to be charitable, I’d say that’s somewhat understandable. Because insurance firms have traditionally sold to, and through, employers, they have never really had to care about member expectations, feelings, or market competition.

But, that’s changing. As consumers’ expectations rise (after all, we are all increasingly entitled) we push back when we don’t get the convenience and value that we get from brands in other sectors. I believe a reckoning is coming for insurance companies and healthcare providers that fail to focus on member experience.

Whether you call them consumers, patients, or members, customers are becoming aware of – or forced into – alternatives to employer-based programs even if they haven’t actually considered switching. Meanwhile regulatory changes have made the market more competitive and the landscape is rapidly changing as new technology-driven providers emerge and non-traditional behemoths (like Amazon, Walmart, Berkshire Hathaway and JP Morgan) consider how they can play a role.

Consumers don’t care about why firms are not delivering on their expectations, they just have higher expectations for service and the reason for brand failure be damned.

Providers and insurers should be scrambling to get their heads around how to manage direct relationships and deliver experiences that at least come closer to meeting consumer expectations. Of course, like most other brands on the planet, they’ll have to deal with the fact that their customer-facing functions are designed to meet performance metrics that have little to do with one another and are often mutually exclusive.

I don’t believe that my insurance company is worse than any other. I don’t think that any of them have stopped to think about what the member actually expects from their relationship. And, I don’t claim to have all the answers.

Although not related to this experience, it’s a timely anecdote. Our team at Atlaas is kicking off research with consumers, insurers, healthcare providers, and experts to get a better understanding of what consumers expect from insurers and providers, the challenges these firms face in delivering excellent (or slightly positive) CX, and seek to recommend and predict how healthcare institutions will adapt in the future. Do you have a perspective? We’d love to hear from you!

Note: This article originally appeared on TheCustomer.net and is posted here with permission.

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