4.30pm June 1st 2020
I hung up after a call with a friend, Linda. She is a mid-career professional working at a rising fintech startup in Jakarta. Similar to others living in the city, she had been home-bound for almost three months due to Covid-19. On top of the enduring stress resulting from the prolonged confinement, she had another concern over how her medical claims would be processed given the closure of businesses, including the insurance carrier from which her company bought the insurance plan.
The problem began
On August 15th, Linda visited a local hospital seeking medical advice for fever and gastrointestinal discomfort. She worried that it could be an early sign of Covid-19 infection. Subsequent testing suggested stomach flu and she was given a prescription. She then promptly paid for the hospital bill thinking that these expenses would be easily reimbursable under her current insurance plan.
Little did she know!
Indeed, the medical expenses were covered, providing that the insurance company had received her reimbursement form along with all invoices. The process sounds reasonable. However, to do that, Linda was required to submit those documentation to a representative of the insurance carrier sitting at her office. That representative is no longer stationed at the office following the WFH policy.
Shen then reached out to her company’s HR department for support. Unfortunately, for administrative matters such as claims, their channel to the carrier was limited to that representative for administrative matters such as claims. Out of helpfulness, Linda’s HR department reached out to the broker from which they bought the health insurance policy. The broker promptly replied with a message asking the sender to be patient since they were all working from home.
Two days later, Linda and her HR department received a reply in which the broker said they would check on the matter.
Another two days went by, the broker came back asking Linda to send an email to the insurer to seek help. As diligent as Linda was, she wrote an email as instructed.
Another three days went by, Linda got a reply asking her to courier her documentation over to an address that was said to be handling claims for the insurer. Concerned about the delivery disruption as well as staff availability during the pandemic, Linda inquired about scanning and sending softcopy over email instead. She was met with a firm assertion that only hardcopy would be accepted, and so her journey continued.
As a millennial, Linda was extremely familiar with the services of on-demand delivery services such as Gojek, Grab and the likes. She attempted to order one to courier her package to the insurer’s office, faster and more convenient as she had thought. To her disappointment, the package was returned since only postal delivery would be accepted. However, Linda did not give up.
Into the second week after her hospital visit, Linda managed to send all the documentation via postal delivery to the insurer’s office. Since then, she had lived with the anxiety awaiting an acknowledgement receipt from the insurer’s Claims department and that her claim would be in process. No acknowledgement was given.
Linda’s story can happen to any of us who has been enduring the disrupting impact of Covid-19. It is therefore pressing to wonder if there is anything else we can do to ease ourselves into the new situation – “the new normal” as experts have been calling.
The quest for a solution started
Linda has been working in technology so her first instinct is to research and find whether any technological solution is currently available to mitigate her ordeal. As meticulous as she was, Linda uncovered “partial solutions” to address her situation: there were mobile applications made available by insurance companies and their third-party administrators (TPA) to support claimants filing claims. However, some of these applications capped the amount for which the claimants could file digitally. Above that amount, hardcopy application would be required.
Upon further research, it appeared that the insurance industry was generally concerned about document forgery using digital means, and hence hardcopy was required as an assurance against fraudsters. During our chat, both Linda and I remained skeptical why hardcopy would make any difference in the case of forgery since the fraudsters could easily print out the hardcopy from the softcopy using a high-quality printer.
Won’t this trust issue be resolved easily by having the hospitals and clinics share patient’s data and records, including bills, directly to the insurers or their TPA for validation? Some carriers indeed attempted to request these data from local hospitals and clinics; their requests were rejected on the ground of violation of patient’s confidentiality.
To further aggravate the problem, TPA and insurance carriers sometimes do not have direct connections to sync up data with one another. These communication gaps among different stakeholders resulted in extensive waiting time in claim processing, contributing toward the claimants’ negative experience of health insurance.
Upon ending the conversation with Linda, I perceived a huge demand for a better way to service and deliver a more delightful experience to health insurance customers.
A new solution – a better experience for all
In order to address the concern over patient’s data confidentiality, we need a new paradigm where an insurance customer should own his or her data instead of hospitals or clinics. The customer should have the ability to create a digital identity account with which they can furnish and store their personal data including health records, and subsequently consent to share the data with any relevant parties for the purpose of facilitating any peripheral transactions, such as insurance claim processing. Under this mechanism, the customer directly determines whether to accept or reject any data access request. Hospitals and clinics, at the request of the patient, would simply input any medical records into their digital identity account. This flip of responsibility removes the legal burden on hospitals and clinics to grant every data access request coming from the insurance carriers or TPAs.
In addition to transferring data ownership to the customers, seamless connections need to be established among other relevant stakeholders such as insurance carriers, TPAs, insurance brokers and employer’s HR teams. These connections can be established faster by having all stakeholders using a unified platform with different interfaces catering to respective stakeholders instead of integrating each stakeholder’s system through APIs because of the excessive amount of time, effort and alignment needed. This unified platform would be a holistic solution to deliver a better experience for all stakeholders in health insurance.
Our team at Aman is looking to reimagine the health insurance experience. If you share our vision, we’d love to get in touch! Please don’t be a stranger and send us a note at email@example.com