Members want the experience of seeking care to be straightforward. They want their questions answered quickly and clearly. Members are consumers who expect healthcare to keep up with the same trends that simplify their interactions with any other modern service provider.
But when their experiences are complicated, intimidating, or frustrating, members delay or avoid care altogether, resulting in poor clinical outcomes and avoidable medical and operational overspending. Some of the leading causes for this–not knowing where to go, how much it will cost, or how long it will take.
The simplest solution is to make answers and information available anytime, anywhere. With the use of AI and natural language processing, virtual assistants can improve the member experience with a single conversation. Here’s how:
Remove barriers to care
“Where can I find an in-network provider in my area?”
Instead of calling the contact center during specific hours and waiting to speak with a rep, or using an online directory, members can call or chat with the virtual assistant when and where they think about it–soccer practice, on the couch at 2 a.m., at the gym–and get an automated, conversational response.
“When does my current coverage terminate? When did my coverage start?”
Once they know where they are going, the providers’ office is going to ask for their insurance information. While this is often a cut and dry answer, they may need to know when coverage terminates (if scheduling an advance appointment), or when coverage started (if newly insured).
Clarify medical costs
“What balance is remaining on my deductible for medical coverage?”
Not understanding how much they’ll have to pay out of pocket for an upcoming service or visit creates considerable anxiety. Having quick access to this information takes much of the unknown out of members’ care.
“Has my claim been paid?”
After a service or visit, members will receive their EOB and may experience sticker shock at the total cost of care. At any point, they can alleviate that worry by calling or chatting with the virtual assistant to check their claim status.
Expedite routine tasks
“Has my prior authorization been approved?”
When referred for a specific service or medication, prior authorization may be required. Not knowing if this is approved or denied can delay care delivery. While this is a routine interaction, most members assume they have to call the contact center, but virtual assistants provide the same information without live intervention.
“Can I get another ID card?”
Asking for a new ID card is easily one of the most common questions that members call payer contact centers about…which makes it one of the most inefficient uses of contact center reps’ time. Virtual assistants deliver the same results efficiently, effectively, and conveniently.
Have you considered a virtual assistant?
Hx Member Virtual Assistants enhance engagement, improve clinical outcomes, and reduce contact center costs in a configurable, HIPAA-compliant, cloud-based, portal agnostic environment.