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Contact centres can improve your client service level

01 November 2011 Andrew Edwards, Liberty Medical Scheme

Today’s medical scheme members feel entitled to efficient and timely service. One of the ways to meet your client’s expectations is to work hand in hand with the medical schemes’ contact centre…

Medical schemes are under pressure to absorb the inflation-plus increases passed on by healthcare providers. But non-healthcare costs, including commissions paid to financial advisers and contact centre overheads are escalating too. These expenses are justified in that healthcare advisers and contact centres are both indispensable in today’s complex medical schemes environment.

Too much choice

Your client faces a bewildering number of schemes and benefit options when choosing a medical aid. “The Council for Medical Schemes (CMS) Annual Report shows there are close to 100 open medical schemes and more than 300 benefit options to choose from,” says Andrew Edwards, Executive Principal Officer at Liberty Medical Scheme (LMS).

“We understands that choosing a scheme and benefit option can be an overwhelming process and therefore encourage members to engage in consultation with accredited healthcare advisers to complete a thorough needs analysis,” Edwards adds. “It’s no easy task for your client to compare various plans and determine which benefit option best suits their health needs, all while taking their personal finances into account.”

Broker experience invaluable

Whilst it is possible for members to manage their own healthcare by sourcing information from a contact centre agent, a medical schemes broker provides greater insight and in-depth knowledge of the industry. Your experience ensures that the client’s medical needs are met through an appropriate mix of cost and benefit.

Medical needs vary from client to client… It is thus essential to discuss your client’s unique circumstances when determining the appropriate medical schemes benefit option. Because your client’s lifestyle needs are continuously changing, be it through marriage, having children, suffering from a dread disease or becoming an entrepreneur, you should complete a needs analysis on a regular basis.

Solving coverage disputes

Edwards says: “It’s against this backdrop that healthcare advisers provide a valuable service, assisting members in deciding which medical scheme option to choose. Advisers can also play an ongoing role by providing advice throughout the client’s relationship with a medical scheme. In particular, the value of advisers is relevant if there are disputes regarding a schemes’ coverage of specific conditions or treatments.

“The steady increase in the number of complaints to the CMS’ Complaints Adjudication Unit, with 5 617 complaints received during 2010/2011, shows that there is an increasing need for member advice when it comes to interacting with their medical scheme. We believe we can reduce this number with assistance from healthcare advisers.”An understanding of a scheme’s products as well as the legal frameworks of the industry put the healthcare broker in an ideal position to intervene and negotiate with a scheme on behalf of the member.

Using the contact centre

Contact centres complement the advisory role by providing administrative support. They provide clinical support, detailed reporting and service level monitoring to ensure that your clients’ queries are responded to in real time. And their structure enables high call-volumes and wide-ranging queries to be dealt with efficiently and cost-effectively.

The contact centre is there to assist with basic queries as well as complex clinical questions. Your client can obtain pre-authorisation for more involved medical procedures, for example. A contact centre is a valuable resource to assist in addressing and resolving your clients many concerns.

Fierce competition

Competition between schemes in the current medical schemes environment is fierce, with schemes under constant pressure to attract new members. LMS believes its ongoing investment in healthcare advisers and contact centres will ensure this competitive edge. Both are differentiating factors that provide efficient communication channels between scheme and member. As such they ensure that medical scheme administrators offer healthcare cover that is relevant, effective and affordable.

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