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The 5 questions health insurance agents answer most

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Today’s health insurance industry mirrors a complicated world in which each of us is faced with seemingly infinite decisions. 

Not only must insurance industry insiders consider a variety of challenges to make well-informed decisions, customers must as well.

But customers don’t spend their workdays thinking about coverage and how it may impact their families. Customer service specialists, on the other hand, are 100 percent focused on client satisfaction. And the best way to serve customers is to find a partner that only thinks about the most efficient ways to make customers happy.

Related: 10 sales behaviors that prospects hate

One factor that has been particularly challenging for customer service specialists in the health care industry is the Affordable Care Act. It brought millions of new potential customers into the fold. But with those new customers came new challenges in terms of scale and specifics. Contact center agents are on the front lines of these challenges, and they are an important component of customer satisfaction. 

First and foremost, customer service agents need to be knowledgeable about the products and offerings they’re asked about. Not only do agents need appropriate training to ensure they understand the company, its policies and its best practices, they also have to keep up with privacy regulations and new technology. This is no simple process.

Related: 7 new Medicare product YouTube videos

For today’s customer, this process often begins with an attempt at self-service. Here’s how it works: Customers go online, input some personal information, and search for their own answers. These people often find exactly what they need.

Other times, this is just the first step. When that customer initiates communication, insurance agents — whether through a live chat, email or direct call — need to have all of the information that person already put into the company system right at their fingertips. This allows for a seamless transition from self-service to representative-assisted service.

Without this, customers are forced to repeat the process of identifying themselves and the problem. On the other hand, when the information is automatically shared through multiple channels, it simplifies the process for both customers and agents.

It also streamlines the process from information gathering to problem solving.

As we enter the open enrollment period, insurers and their representatives need to be ready for the bevy of inquiries from new and existing clients. With thousands of people aging into Medicare each day, businesses also need to be prepared for a flood of calls and questions.

Customer managers should ramp up capabilities as seasonal needs change. This allows the right agents to be available at the right time. It would be nearly impossible for a business to expect to have this type of internal flexibility. Bringing in a partner (like my company, Convergys) to act as a trusted extension of your business, frees up executives from worrying about the specifics of communicating with individual customers to focus on big picture business strategies.

Customer service representatives in the insurance industry are at their best when they have a foundation for success. (Photo: iStock)

How can insurers empower their agents to succeed? Consider this: Eighty percent (80%) of Convergys health care agents are licensed experts in the field. Some of them come to the company with this certification, but most new agents go through two weeks of licensing training before they even begin the extensive 5-7 week process of client specific training.

Part of this process is learning the company, but it’s also about mastering the technology. As the health insurance industry adapts, the use of chat and other interactive online and mobile services is crucial. Agents need to be skilled at voice, mobile and chat while simultaneously handling the details of a customer’s options.

Related: 4 reasons why insurers must adapt to the omnichannel world

It’s not an easy task, but representatives with the right training can balance the demands effectively.

When most businesses consider customer service, it is generally in response to a customer request or complaint. But when it comes to the health care industry, proactive efforts can be equally important. If a patient goes to the doctor, receives a diagnosis and a prescription for medication, he or she has taken the initial steps towards resolving or dealing with a situation.

However, it’s not uncommon for patients to leave it at that, and not head to the pharmacy to actually pick up that prescription.  Customer management companies can proactively reach out to patients to remind them to follow medical advice and fill (and refill) prescriptions. This is often a vital service for patients who may need the extra push to take care of themselves. This proactive approach also is necessary for preventative appointments like prostate screenings and mammograms, as well as other regular testing needs.  You could say that this type of outreach can actually save lives.

Related: The advisor’s guide to “talking boomer”

Understanding that healthy people make for more productive employees, an informed workforce needs to be a top priority for every company. Making these complicated customer service interactions pleasant and efficient is the mission of customer service management companies.  You can trust that your business will benefit from having a strong system supporting and informing employee health care decisions as they deal with the ever more complicated landscape. Having top-notch agents, trained and ready to respond is the best path to accomplishing that goal.

Keep reading for answers to the five most common health insurance questions posed to insurance customer service specialists.

Having top-notch health insurance agents who are trained and ready to respond is the surest path to empowering people to make informed health care decisions. (Photo: iStock)

Having top-notch health insurance agents who are trained and ready to respond is the surest path to empowering people to make informed health care decisions. (Photo: iStock)

Most common health insurance question No. 5:  I had a breast exam done and the doctor found a lump. I need a mammogram. I know that it is $0 for my annual mammogram, and the last one I had was a year ago. Will this new procedure be covered?

Answer: No, that will not be covered as your yearly mammogram exam. This is because the yearly exam is only for a preventive service. Since a doctor will do this mammogram in response to finding a lump, it would be considered a diagnostic test. If you would like, I can provide you the benefits of diagnostic testing.

Related: 6 places where cancer attacks U.S. women outside the breast

Most common health insurance question No. 4: I went to the pharmacy to get my prescription and the drug price went up from last time! I cannot afford the higher price. Can you explain why this is happening? Or if there is any way you could help lower my prescription price?

Answer:  Yes I can, after doing further research, I noticed that the medication went from a Tier 2 to a Tier 4. This caused the price of your medication to go up. I can provide you with the number to give your doctor to possibly get a tier exception. This helps keep your drug at a lower tier and in turn you will have it at a lower cost.

Related: Medicare Part D plans cover fewer drugs

Most common health insurance question No. 3: I just received a hospital bill for a surgery I had a while back. Why am I now getting billed?

Answer:  I would be more than happy to look into the claim for you to get more information on why you are getting billed.

Great health insurance agents help cliest easily navigate in-network versus out-of-network providers. (Photo: iStock)

Great health insurance agents help clients easily navigate in-network versus out-of-network providers. (Photo: iStock)

Most common health insurance question No. 2: Is a doctor I’d like to see in or out of network? What can I expect my out of pocket expenses to be for these services?

Answer: We can look to see if your specific physician is in or out of network (OON).  We will review our services, physicians and networks to determine your coverage while providing deductible, copay and out of pocket maximums for the services you need and are getting.  We can also help locate in network physicians in instances where you are exploring OON providers.

Most common health insurance question No. 1: Why wasn’t my claim paid the way I expected it to be?

Answer: We are very thorough in our investigations of claims like yours. We encourage an investigation of the services and claim submission process while comparing the covered benefits and outlined processes in order to advise you of next steps. These steps may include walking you and your provider through the appeals process, understanding your responsibility as a patient, and looking at the potential of submitting claims differently in the future.

See also:

10 Medicare facts for agents who know everything

6 questions about containing health care costs in retirement

5 sales tips learned from a small town impotence doctor

How to insure your pot-smoking client

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