April 2016 – Member Services Message Platforms

For generations that came of age in the era of texting and messenger apps, phone calls are often the last resort when making customer service inquiries. Demographics aside, trying to navigate a complicated, automated phone tree to speak with a customer service representative is usually a cumbersome and time-consuming process. To that end, this Healthcare Monitor Report reviews the various member services message platforms offered by our coverage group. For this report, we reviewed the nine Healthcare Monitor health plans that offer message platforms for members on their public or private sites. We examined the overall organization, location and effectiveness of three prominent customer service mediums: live chat tools, online message centers and individual web forms that allow members to send customer services representatives account and plan-related inquiries.

Specifically, this report focuses on the following aspects of each organization’s member services message platforms:

  • The health plans’ effectiveness in preparing members to reach out to customer service representatives
  • The way in which firms respond to these inquiries through online channels
  • The availability, usability and capability functions of the three customer service mediums

Of the nine firms that offer member services message platforms, 33% offer live chat or virtual tools, 67% offer member site message centers and 44% offer public site forms. Only one firm in this report provides a member site form but does not offer a message center, live chat/virtual tool or a public site form. One hundred percent of the centers and online forms are accessible via a public or member site Contact Us section, but only 44% of firms feature member homepage icons that alert members of a new message or task.

Eighty-eight percent of the health plans specify the services and types of inquiries members can make through message subject options. Message subjects help members fine-tune their questions before engaging member services and avoid confusion for both sender and receiver. The most common inquiry subjects on the forms and message centers include coverage, benefits and claims-related questions (89%). Billing, pharmacy and technical account-related message subjects are provided on 56% of the message platforms. An Other option, available on 78% of message centers and online forms, allows members to ask about anything not covered by the preset options.

Member services response quality were the most consistent across the coverage set, and all responded well to our inquiries. Responses from both virtual assistant tools provide supplemental links to corresponding pages, and Aetna’s tool auto leads members to the appropriate site page or section. Of the six firms that offer a message center, all responded to our inquiry in less than 48 hours and five directly answered our inquiry within the first response.

Among the coverage group:

  • Members can perform searches for message on only one message center
  • 22% of the message centers offer interstitial alerts of new tasks or messages, and 22% send emails when the member has a new task or message
  • 44% of the customer service representative responses encourage members to follow up with additional questions through the telephone service
  • 33% of the message replies request member feedback
  • 56% of the forms and message center inquiries allow members to attach a document to messages
  • All virtual service assistants are advertised as females