In a landscape where insurance is still largely traditional and offline, the real-life experiences of our users offer us valuable insights. These experiences help us understand what to focus on and what to avoid in the digital insurance realm. The biggest challenges we've identified are clear communication and trust-building, particularly when users are faced with high-pressure decisions.

We're excited to share our first story featuring Vijay. His experience underscores the critical importance of clear communication, even when there's adequate knowledge about insurance, especially in emergency situations.

UX research field notes

We're excited to unveil a new series that delves into the heart of user experience: stories annotated with insights from our field notebooks. These aren't just narratives; they're enriched accounts that provide a deeper understanding of user behavior, complete with observations, sketches, and data gathered during our research.

The incident

In the early morning quiet of Coorg, the loud siren of an ambulance cuts through the silence. A middle-aged man, holding his child's hand, steps out of the ambulance and into a local hospital. Right behind him, a stretcher is wheeled out carrying his elderly father, who appears unresponsive.

Vijay and his family were enjoying a long weekend vacation in Coorg when they were suddenly faced with this unexpected emergency.

Vijay: 

“ So I took my family and parents to this place called Coorg, 40 kms from Bangalore, it is a hill station. My dad suddenly started feeling uneasy there, he was not able to breathe. Immediately we got an ambulance and went to a local hospital and then got our COVID test done. Everything was negative. But the breathing issue persisted. The doctors advised that he (Father) has to be on oxygen support for two-three days, at least. At three o'clock in the morning, we couldn't go to any private hospitals. And moreover, there are no good private hospitals”.
“The doctors suggested that there are only two things— Either I will have to take them back to Bangalore on oxygen support now or we will have to let him be there in Coorg itself for another three days.  In that case, I decided to take him to Bangalore. We got him to a hospital close to my home (Bangalore) because it's easy for us. I cannot be in Coorg and get him hospitalised. So, we took an ambulance and rushed back to Bangalore. Our vacation turned out to be sad”.
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Researchers note: Hospitalisation is an affair that no one prepares you for. Moments of lapse in judgement can haunt us with regret forever. Choices are crucial and difficult at times such as this. Only a trusted hospital could, if at all, soften the blow. This clearly points to the fact that as Plum, we have to be mindful of where the network hospitals are situated. Are we accessible at all times, wherever users are?

Dampening room rent

The ordeal didn’t end by just transferring the patient to Bangalore. During the admission process also, Vijay had to take crucial decisions that could alter the course of hospitalisation. 

Vijay:

“Unfortunately there were no sharing rooms available in the hospital near my home. We had to take some room, which was costing us more. But within my budget”. 
Usually I wouldn't have gone to those executive rooms and all. Until now I have not done that. But this time I didn't have an option. So I availed an executive room and then got him admitted for 10 days. When I inquired about the rent charges and all, It was pretty much well within the budget, 2% copay of my coverage. So I agreed ”.
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Researcher's note: Since Vijay is the sole earner in his family of five, he plans ahead, even in extraneous circumstances, he is thinking about insurance and the budget (sum-insured). He relies heavily on insurance for such emergencies. Being a senior HR, he is also quite abreast with the insurance knowledge and has taken an informed call.

Despite the informed decision-making, Vijay stumbled upon a few roadblocks.

Vijay: 

“So till then I never had this issue of cash. I always submit cashless. Everything used to go smoothly. I hardly used to pay, probably 10% of my overall bill. This time, I unfortunately had to take an executive room. And then the bill was also a bit higher than my copay, there was some error. 
When they were calculating the cashless benefit or giving whatever cashless clearance. They considered the treatments based on the room rent. All the other charges have gone up because it's an executive room, all the treatments, doctor visits, tests, whatever has been done in the executive room was actually more than what happens in the general ward”.
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Researcher's note: No amount of preparedness and knowledge about insurance translate to the actual experience one can have. Vijay is someone who has had past experiences of going through complex insurance processes in the 15 years of his work life. This time around though, bureaucratic hospital processes and compliances threw him off guard. All his calculations went for a toss. He didn’t anticipate that the hospital would throw in a wet towel. 

During discharge

Vijay only noticed the discrepancy in the amount when they were about to be discharged. Although the money exceeded his budget he knew that his insurance would cover it. That he was eligible for a higher amount.

Vijay:

“After the clearance came, when the hospital asked me to pay the remaining amount, I went to the insurance vendor in the hospital and asked him about the humungous hospital bill. And that's when they told me about the room rents and with additional charges for doctor visits and everything else. Even if it is more, I am eligible, that's what I was saying. So, it's more this time, but I am eligible. I cannot fight with hospital guys, saying that they never told me that I'm eligible. It's the insurance vendor (Plum) who said I'm eligible”. 
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Researcher's note: Multiple back and forth left a bad taste in his mouth, especially at the time of discharge. The game of he-told-she-told was quite evident in making Vijay lose his time and patience. The miscommunication, and no personal support delayed Vijay’s clearance and therefore discharge. Vijay had to bear the brunt of a clerical error from insurers’ side and the distrust that conspired between hospital and the insurer.
We as Plum cannot prevent the clerical error from the get go. What we can though is, set the right expectations during the users hospitalisation and ensure they are getting adequate support.



Vijay: 

“24 hours is okay. 48 hours is tolerable and anything after that, it's a nightmare. Especially with aged people it's even worse. So my dad was like, ready, all set, ready to come out. And then the insurance amount came, and then they asked me to make the additional payment. My mindset was to leave the hospital immediately so I wanted to make the payment.
The govt doctor set an expectation of 2-3 days minimum, and here we have already spent 8 days extra. My dad just wanted to leave and he was not ready to listen to anything.
That point of time. I can't run around behind the insurance clearance and all those things. Whatever is done it’s done, whatever is clear is clear”.
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Researcher's note: Phew! Clear communication is paramount. Especially during discharge when the patient and family are in a hurry to leave the hospital. How might we avoid prolonged discharge processes and support users to finish their paperwork at the earliest?

 Vijay: 

“So then I spoke to Plum guys, they are my point of contact. And they said they will rectify the error. They agreed that it was a mistake. They advised me to pay and leave for now and get it reimbursed later. That's how it happened. It took like two-three hours, and after talking to two- three people, escalating and all those things, we got it done. I haven't got the money, but at least someone agreed that they will make the payment”.
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Researcher's note: Vijay’s reaction is justified at this stage, because no one was owning and taking responsibility. He was in a state of limbo, running helter-skelter along with the surmounting pressure from the patient who had been in the hospital for longer than anticipated. Users look for assurances in the end from their service providers. 

Vijay:

“Then, it's all sorted out. That is anyway now a six months back story. After I got out of the hospital, Plum asked me to fill a form which I didn't do immediately, which I was not ready for. Initially it was to WhatsApp claim and all that, that somewhere didn't work. I tried multiple times. I connected with customer care. It didn't work. And then they gave me a form, which made it even worse for me to fill the form, print, sign, scan, and all. Then I said, okay, it’s not gonna work out but after waiting for sometime. I actually submitted the form yesterday”.
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Researcher's note: Users like Vijay, who are habituated to filing the cashless claims are averse to long drawn processes and breaking their pattern is a task. The product has to adapt to their mental models and be malleable for any user to take right action. 

Final thoughts
If we observe carefully, digital products in insurance have to match to this level of scrutiny when the users are in distress. The question is, how might the product replace 3-4 phone calls to pacify the situation? And can it ever replace the human-touch? Guess, it all begins with the way we view our users. He is someone who relies on insurance during emergencies. Therefore the responsibility falls on us to empower this human.

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User Research