3 questions to ask a carrier about their member experience
Many Americans find it challenging to navigate the U.S. health care system. Carriers should be making it easier for members.
The unique value any health insurance carrier offers goes well beyond benefit plans and their costs and scope of coverage. The member experience is an integral part of any carrier’s value proposition — and not only because employees today expect a seamless, retail-like digital experience. Yet a majority of Americans — 61% — say that navigating the U.S. health care system is a hassle, and 53% feel it treats them more like a number than a person.1
In other words, there’s plenty of room for improvement to the U.S. health care experience. When evaluating different benefit carriers, a broker, consultant or employer should carefully consider the member experience offered by each. Ending up with a subpar member experience doesn’t only negatively impact members. If that experience falls short in comparison to their current carrier or broader consumer expectations, a broker, consultant or employer could open themselves up to the risk of increased member noise. Complaints and frustrations voiced by members can take brokers and consultants away from their clients, and employer-side HR leaders and teams away from day-to-day work responsibilities.
That’s why asking the right questions of carriers during renewal periods can be critical. Here are 3 key questions, drawing on common member experience expectations and pain points.
1. How do you address member issues?
Many health care consumers find it challenging to understand their coverage and benefits information. When a billing or claims issue arises, frustration can quickly set in if resolution seems far off. Advanced chat capabilities that leverage AI-assisted technology can help address issues quickly and efficiently. But sometimes, human support is needed: Excellent customer service (such as advocates with whom members can call) is just one way carriers can quickly resolve issues.
Ideally, a carrier should take a more proactive approach to identifying and resolving issues and engaging members. For example, a carrier’s client management team could embed support staff, such as a dedicated on-site service account manager, to deliver a more supportive health care experience to members. This is a strategy Minneapolis Public Schools has employed, and their employees have seen improvements in their ability to navigate their health care journeys.
2. What’s your digital experience like?
In 2025, a high-quality digital experience is essential. Done right, it transforms the overall member experience by making the right information easily available across devices. A standout digital experience is at its core about simplicity and accessibility.
Every member should be able to easily take advantage of digital offerings spanning from virtual care to intuitive provider search capabilities. The digital experience should help members more easily navigate the health system, connecting them to the answers and support they need to make decisions that drive better outcomes. It should boost member engagement, as recent UnitedHealthcare digital enhancements have.
3. How are you streamlining access to care?
Every member has a different health care situation. The more a carrier can deliver personalized services to meet members’ unique needs, the more supported members will feel to make more informed care decisions. Robust member advocacy services can make a meaningful difference — and take multiple forms. A carrier could provide particular members with special needs or complex, chronic conditions with information and insights personalized to their care needs and support them with access to a dedicated and trained expert who can provide 1-on-1 guidance.
Carriers that also leverage data specific to employer groups and the individuals within their member population (such as eligibility, claims history and demographic information) to proactively help members avoid unnecessary costs and connect them to resources and solutions geared to their unique needs can help.
In addition to providing personalized support, it’s important to evaluate all the ways in which a carrier is working to remove obstacles for members that can impede speed or quality of care. This is being seen through efforts to reduce the volume of prior authorizations when and where appropriate or to create greater interoperability between the systems carriers and providers use.
Share
