The top-five healthcare payer faced a challenge after introducing new Marketplace (ACA) plans as part of their lower-premium product portfolio. Some members missed out on information about important plan limitations, resulting in complications and dissatisfaction. For example, virtual-only plans and plans requiring referrals proved to not be the best option for some members.
At first, the payer didn’t have an outreach solution to educate new members about these plans. This meant that dissatisfied members faced a rocky path to understanding the limitations of these newly designed benefits. In some cases, this education gap could lead to grievances and disenrollments.