CX Chronicles : What Happened to CX? [ The TPA Case study ]

12 Nov 2021 : What does one expect from a Third Party Administrator(TPA) for Health Insurance benefits?

I will try articulate as a customer :

1) A Contact number where one can call to speak to someone who can assist with queries and reimbursement related matters.

2) A Website where one can go to to get additional information and some self help if one can login and check insurance details and associated benefits Eg : Eligibility related queries etc

3) An App would be nice in case it can help one when on the move

4) A Complaint Care team who can handle any Complaints that may come up as we do not live in a perfect world.

Now, i will share my experience :

Stage 1 : The enquiry on eligibility

I tried reaching the team to enquire about if the policy was eligible for Dental services. Unfortunately, i did not get a clear answer, but, at least got clarity that i the policy permits dental procedures up to a specific budget. This information, to get, was a challenge as the emirates id was not linked to the insurance card and thereby the identification of the user took unreasonable time. I urged them to fix it so it is not a challenge in future. (There can be tech intervention to make sure all cards are linked to Emirates ID without exceptions)

Stage 2 : The Post treatment submission for Reimbursement

I contacted the team and was advised to submit the forms and scan copies via app so i can track the progress. Submitting a claim via app looked a challenge as it involves attaching scan copies etc. I opted to trust their process and send n the request via email and wat for the 25+ days they said it would take for the claim to be processed.

Observation : Even if the submission is done via email why not have the possibility to be able to track progress via App/website. Don’t we all love tracking that Amazon order🤩🤔

Stage 3 : The Follow-up

The Fun begins now. 29 days after, when i called to check upon the status, i was told the processing is complete(May be it would have been nice to receive a SMS or Email intimating the same. Is that difficult?). Nevertheless, i was glad.

I was told that the Banking information is missing and the agent asked me for my banking detail. As it was for a credit, i went ahead and shared my banking information via Call thought it sensed odd. I also requested if someone can share or detail the calculation based on which the refund amount was arrived at(as an amount lesser than the amount spent was being reimbursed). The associate said she is leaving a request for the same. As i was anyway on the app, i went ahead and updated the banking account information.

1 week. Nothing happened. I called again and the associate this time said the banking detail is still not there. I was surprised. I explained what happened on the last call. He said he will check & call. He came back the next day(but, at least he came back) and repeated the same lines. Banking detail yet to be updated. I finally expressed my disappointment over the unreasonable delay. He promised, he will investigate and will get back.

1 more week went by. I called and this time i was once put on abrupt hold and eventually got disconnected. After 2-3 failed attempts, i managed to speak to an associate who was not wrong at all but was just “Mechanical”. I guess an intelligent machine could do the job little better. No Empathy & No Concern. The associate even mentioned : This is the first time i am assisting you; so…i was speechless. After a 15 min hold(with my permission), i was told the supervisor will call back before end of day.

After an hour, i receive an email(please note, NO call) apologizing and informing me that them matter will be resolved in 2 days. Observation : Wasn’t a promise made that a senior manager will call? Whatever happened to empathy !!

As i had no choice, i shared the agony with the Insurance company point of contact hoping for a resolution.

What happened to & with Customer Experience in this incident? The TPA had a Snazzy website, a good looking App and a team in place. But…

To me, it was an experience i wouldn’t wish for my enemies. The following attributes surfaced in my mind : Promises / Empathy / Ownership / Care / Compassion / Attention / Extra Mile !!

Where were they? in the App? / embodied by the Customer care team? or integrated into the good looking Website?

Where has Customer Experience (CX) gone?/ gone wrong?