As we started yet another day of user calls, little did we know that today would touch our hearts in ways we didn't think it would. In our roles as User Researchers, we often find ourselves on these calls bridging the gap between data and empathy to make insurance claims a smoother experience for our users. But today, we encountered a story that reminded us of the human aspect of our work.
Amala, a name that will forever echo in our hearts, shared her story. She had filed a hospitalisation claim for her mother, a simple transaction on the surface but a profound chapter in her life. Amala works as a call centre executive with a small firm in Bengaluru. Her work keeps her away from home most of the time, leaving her aged mother in the care of her maternal uncle after her father’s untimely demise a few years ago.
When calamity struck in the form of her mother’s hospitalisation, Amala found herself standing at the crossroads of despair, with only her uncle to lean on. As we share this story with you, we hope it resonates with you. It highlights the importance of not just improving the processes, but more importantly, making a difference in the lives of whom we serve.
Ten minutes into the call, our hearts sank as we came to the painful realisation that this was not just a routine claim. Amala lost her beloved mother to heart attack after a gruelling 48 hour battle in the ICU.
"My mom passed away. It was sudden and unexpected. At that point in time I didn’t have the consciousness or the presence of mind to check for a cashless hospital. We just took her to the hospital that my uncle knew."
"I would have definitely made better decisions in a different scenario."
Researcher's note: The list of cashless hospitals and other guidelines that we provide to the users in critical situations can become ineffective if the user is not in a rational frame of mind to use them. The natural instinct to turn to kith and kin for assistance proves to be a challenge for our product’s adoption and effectiveness. While our goal is to provide valuable guidance and assistance to users during challenging times, we must recognise the complex emotional dynamics that can influence their decision-making.
Gathering the Documents
“My mom’s health was declining fast. I never felt more powerless. My uncle and cousins took care of the bills and would do the runs for medicines and supplies. I didn’t keep track of anything.”
“And when mom passed away, it was a surreal moment for me. I just remember hailing a taxi and bringing her home. My uncle wrapped up everything after me and headed home later. I don’t know what documents the hospital gave him, but only later I realised they were not enough. They didn’t give him the authorisation letter, which in case of death is one of the most important documents.”
Researcher's note: Users often neglect to gather the essential documents required for a claim, typically only considering it as an afterthought once the crisis is behind them. It's crucial to recognise the product's impact that goes beyond the individual user.
The challenge we face is this: How can we effectively extend support to family and friends who step in to assist our users during moments of crisis?
Amala, unfortunately, wasn't aware of the time limit for filing the claim until the HR department informed her about the 45-day deadline, which was a moment of realisation and potential stress for her.
“I filed the claim after almost one month after discharge. I was still coping up with the loss, but I had to file the claim because that amount is just too much for me to bear out of my pocket. Plus I already spent a fortune on the funeral.”
“The hospital was in a different city, more than 100 kms away and Plum kept sending me reminders that the documents were either wrong or insufficient. I had to make as many as three round trips to the hospital to get all the documents.”
Researcher's note: Failure to promptly file claims results in a growing difficulty in obtaining hospital documents. Hospitals grow less responsive once bills are settled, leading to prolonged document retrieval times. Many users lack the time and resources for multiple hospital visits.
We need to understand that we may not have done enough to motivate users to file claims promptly, especially when they are facing difficult circumstances.
“I filed OPD claims and other claims in the past for myself and my mother, but this experience was unlike all those experiences.”
“I always felt that I am someone who is well informed about the insurance claim process, but navigating a reimbursement claim during mom’s death, especially when the hospital is in a different city turned out to be a nightmare. The most frustrating part was not having direct access to a customer care executive. Since there’s no specific person assigned to the case I had to reiterate my scenario again and again to each new person.”
Researcher's note: The user's previous encounters with filing OPD and other claims contrasted starkly with the challenging experience of handling a claim related to a death. Despite considering themselves well-informed about the insurance claim process, the ordeal of navigating a reimbursement claim during death, particularly when the hospital was located in a different city, turned out to be a nightmare.
The absence of direct access to a dedicated customer care executive emerged as the most pressing concern. Repetitively recounting their situation to different PoCs, compounded their frustration.
A long wait
“I was almost giving up. For one whole month I was just endlessly collecting all the required documents and once they were submitted there were no updates for 2 months. I was getting anxious and reaching out to Plum constantly about why my claim is taking this long. They tried their best to assure me and update me on the status, but I was very unsure if I would even receive anything.”
“My uncle took care of all the hospital expenses and I felt bad that I was taking too long to repay him. It’s a lot of money even for him.”
Researcher's note: For lower-income users, swift reimbursement is absolutely critical. Borrowing money from family, friends, or informal sources adds to the pressure for prompt repayment, often leaving users uncertain about when they will receive the funds. Thus, it is important to establish transparent expectations and offer unwavering support and reassurance during these critical times.
Amala finally received 80% of her claim amount after enduring a challenging three-month wait. While her reimbursement journey concluded on a positive note, there remains a significant journey ahead to improve the process for users like Amala, who have already faced the tough battle of loss and grief.