The secret to healthcare AI is ... human beings

Nobody goes to the circus to see the net. But when the high-wire gymnast slips, the net is suddenly the star of the show. So, don't think of me as being in the health insurance industry, the safety net of your life. I don't want you to stop reading. I’ll tell you I’m an expert in customer service and have been persistently challenged by innovators in the retail and tech space who have conditioned the consumer to expect instant responses, instant results and instant products.  

Given the complications, verifications and regulations inherent in the health-related insurance industry, processing some insurance claims in just days, believe it or not, is a major accomplishment. Turn-around times are shorter now, especially for routine wellness appointments … often only a day. Who, we thought, could ask for anything more? 

Well, everybody, that’s who. 

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"If top retailers can deliver my purchases within hours, why does it take so long to simply credit an insurance claim to my bank account?" Lots of reasons, actually. That’s the unavoidable but boring part of the health-related insurance industry. Boring, that is, until we invited the customer in for a looksee. 

For instance, a past inspiration was found from a well-known pizza chain to provide customers progressive notifications from contact, to filing, verification, approval and payment. Policyholders told us they appreciated watching their claim cook, sizzle, crisp and emerge from the oven. And as their stress levels declined, so did the inquiries to customer service. No surprise. It’s how humans are wired.  

Owen O’Kane, psychotherapist and author of "Ten to Zen: Ten Minutes a Day to a Calmer, Happier You," notes that even the smallest positive future events can motivate us and reduce anxiety. That’s why people look forward to planned vacations, bonus checks, tennis court reservations and, yes, insurance claim settlements.  

Artificial Intelligence is now heralded as some magic fairy dust that eliminates time from all transactions. Certainly, AI and machine learning have a place. For predictable and repetitive tasks, bring on the bots.   

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In some cases, AI can induce safety. Heck, even when the anti-lock brakes smoothly stop your car on an icy day, AI is at work. We need such technologies. In our case, to identify contingencies, eliminate errors, calculate trends and quickly equip our customer service representatives.  

But the fact remains that making pizza is predictive, repetitive and impersonal. Health-related insurance is not. Turning to bots is a non-starter. ("For breast cancer, press two. For colon cancer, press three.")   

Fact is, humans aren’t just "good" at empathy, compassion, listening, nuance, etc. They are essential to it. And in our world, empathy is part of the product. 

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When our policyholders file a claim, it’s often on the worst day of their lives. If they don’t see/hear/feel real people on the other end of their exchange, we’ve fallen short of their expectation, and therefore, can’t hope to satisfy, let alone delight, the customer. 

Therefore, in this age of AI-driven algorithms, analysis and assessment, human beings are, ironically, our secret sauce, our competitive distinction, our innovation. People are our path to providing the type of personalized, and personal, service customers expect. AI helps them spend more time doing it.