The Case For Coverage Clarity: Why Health Insurance Providers Need To Make Things Clear

Have you ever thought about going to the doctor and questioned, even momentarily, “Hmm, I wonder if my insurance will cover this?” Or have you ever received a medical bill that was higher than expected? If so, you know these situations don’t elicit a great feeling — and you’re not alone.

The fear of not being covered or the disappointing surprise of finding out you owe more than expected are all-too-common and unpleasant feelings that customers face when it comes to dealing with health insurance companies.

We used Forrester’s Customer Experience Index (CX Index™) Consumer Perspective Online Community to understand specifically what consumers feel when there is lack of clarity surrounding policy coverage details. They say: 

But the key question you are probably asking yourself is, “Do these negative emotional experiences matter — do they affect the bottom line?” We find that the answer is a resounding “Yes.” Lack of clarity or fear of not being covered impacts the overall emotion a customer has about their health insurance provider, which in turn significantly impacts their likelihood to recommend their health insurer to others.

Our CX Index data for the health insurance industry shows that consumers who indicated their health insurance provider did not make it easy to understand what their plan covered reported nine times more negative emotional experiences overall than those who understood their coverage and less than one-quarter are willing to recommend their insurer to others. On the flip side, those consumers who agreed that their insurance company made it easy to understand their coverage were over three times more likely to report having a positive emotional experience, with three-quarters of them willing to recommend the brand to others. That is a 3X-magnitude difference in advocacy loyalty, which influences a company’s potential incremental revenue generated by customer acquisition.

The moral of this story is that when it comes to health insurance, coverage clarity and emotion are intertwined, and emotion’s influence can have a significant impact on loyalty, especially advocacy loyalty. And, as we know from our CX/revenue models, the higher a customer’s loyalty, the larger the amount of incremental revenue a company can receive.   

Do you make it easy for your customers to know what their policy does (and doesn’t) cover? Are you collecting metrics to see how well your customers understand their coverage? If you’re not sure, the CX Index team can help! To find out more about what the CX Index is, go here

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