How to help members understand their insurance and health

December 10, 2020
Josie Rasberry

Anyone involved in health insurance knows that people need help understanding their coverage. That’s the whole reason HR walks employees through their benefits package, and why health insurers offer member support. The language around health insurance can be very confusing, which can add to an already stressful healthcare situation. So, we’ve created a guide to help you help your members.

Use less complicated language.

Did you know that most health insurance and medical documents are in a tenth grade reading level? The average American reads at an eighth grade reading level, and 20 percent of adult Americans read below a fifth grade level. It stands to reason that, at the least, health insurance content should be in an eight grade reading level.

Payers need to break from the status quo of using confusing terms and jargon in their coverage documents. Think about how you would explain what a deductible and copayment is to a friend that’s never had health insurance, and then put that into your explanation of coverage packet. Which leads to the next point of also condensing information as much as possible. No one wants to read a thirty page packet.

Providers are guilty of using complicated language as well. They throw out medical terms without explaining, or the billing department creates medical bills that are full of confusing codes and lead to patients not understanding how to pay.

Health education.

Unfortunately, sometimes members don’t entirely understand their own health needs. This could be because their provider didn’t take the time to fully explain, or the member has misconceptions or misunderstandings about their health. Payers can offer tools and simple education materials to help members understand their health. When members understand how their chronic condition affects them or are finally able to pinpoint their illness, they can make wiser decisions. These informed decisions will help patients feel better and save the money that might have gone towards unnecessary care.

Payers can be proactive about this by assessing how many of their members share health issues. Do you have several members with diabetes? Coordinate with a diabetes specialist to create helpful and simple materials so these patients can better manage their health.

Patient advocacy.

We mention patient advocacy a lot, but it’s because it is helpful in so many areas of healthcare. Beyond having member support or a benefits specialist at your company (both important and needed) payers can also have a patient advocate dedicated to helping members understand their health insurance. Having a person or team that a member can call or message to ask questions would make a huge difference in a member’s understanding of healthcare. The convenience of being able to text a patient advocate anything, such as, “what’s the difference between a copay and coinsurance?” would help members to learn about their coverage and feel more confident making healthcare decisions.

When you work in healthcare or health insurance, it’s easy to forget that not everyone understands it like you do. You might think it’s very simple to understand the difference between a high deductible plan and low deductible plan, but for a young adult just entering the workforce or an elderly person getting health insurance for the first time in their life, all these concepts are completely foreign. The added stress of finances and health issues doesn’t help either when someone is trying to understand complicated health insurance jargon. Payers have a responsibility to help their members understand their options so that they can make the best healthcare decisions possible.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

You might also enjoy.