Health Insurers Miss the Point on 'Empowerment'

Health Insurance

By Linda Adler

Learn more about Linda on NerdWallet’s Ask an Advisor

I recently attended a conference where a panel of executives from the insurance industry talked about promising technologies that are just around the corner. They described tools that would enable their companies to more efficiently access patient data to better understand outcomes, while simultaneously using claims data to promote better disease management.

Terms like “patient engagement” and “patient empowerment” were a big part of the discussion, and there was obvious pride in the executives’ descriptions about what they believed would provide better patient care.

So it was disappointing that when I returned to my office I was met with two voicemails from frustrated clients that made me think hard about the gap between the executives’ glowing visions and the day-to-day reality for too many consumers.

The first client was an intelligent young woman, newly pregnant, who had recently signed up for new coverage. Before making a choice, she had conducted a careful and thorough review of her options — calling a representative at each company to make sure she understood the ins and outs of their policies and taking screen shots of key pages from their patient handbooks for reference and comparison. She ultimately picked coverage that provided both optimal prenatal and maternity care, feeling confident that she would be in good shape both from a medical and financial standpoint.

The problem? When she started using her benefits, the insurer refused to pay for most of her care. It said ultrasounds, blood work and other routine aspects of her prenatal visits weren’t covered, because they weren’t actually part of the prenatal program. Her insurer told her that it would cover only routine conversations with her doctor.

The second call was from a client who was no stranger to the medical system. This young woman has lived with Type 1 diabetes for most of her life and understood the health-care system inside and out. She came to us through a reporter who thought we might be able to provide assistance. Her challenge? Her insurer suddenly refused to pay for the basics, like her test strips, and no amount of appeals seemed to solve the problem. She had enlisted the help of her doctor, who had written numerous appeals on her behalf; she had contacted the state insurance department, where her paperwork was lost; she had finally gone to a national reporter in hopes of getting her story heard.

After we investigated, we determined that a number of changes had been made to her policy, but the changes were never clarified in a way that helped her understand the implications. A simple explanation would have saved a lot of time and energy on both sides.

Unfortunately, people in my line of work — patient advocacy — see this kind of thing all the time. Developers create sophisticated new technologies, and health-care systems dedicate enormous amounts of effort and resources to new practices designed to promote better care — and yet patients are more frustrated and less satisfied than ever.

This is because patients think of engagement and empowerment differently than insurers do.

Patients are looking for clear and comprehensive information that helps them understand what’s covered and what’s not. Most patients aren’t focused on buzzwords such as “big data” — they want to know how they can cover their own medical bills. And in doing so, they’re looking for customer service, delivered in a way that makes them confident they’re getting the value they were promised when they signed up. They want their inquiries handled with respect, and they want to talk to people who will listen to their concerns and respond efficiently and competently.

There’s still a huge, important role for technology developers here. They can facilitate the transition to optimal customer service, where insurers treat their customers like the better consumer-focused companies already do. They can create systems that reduce phone wait times and promote chat and email protocols that enable sharing of coverage information in real time. They can promote transparency about how claims are handled and paid, and provide resources that help consumers understand exactly what is going to be paid and what is not.

If insurance companies want to create engaged, empowered patients, they need to start at the beginning — with their pocketbooks.