Sentiment of the Week: Drama in Health Insurance

By: Dheepan Ramanan

May 14, 2015

customer experience
Customer Feedback
Sentiment Analysis

Have you ever wondered why doctors and hospitals inspire so much fiction? The sight of garish green-grey scrubs, surgical masks and shower caps grace our television screens daily because medicine is inherently dramatic. From the absurdist comedy of Scrubs, to the hope and romance of Grey’s Anatomy to the coal-choked industrial air of The Knick, medical programs take a slice from the rich gradient of emotions in medical practice. For most of us, real medical moments are few, but they are intimately connected to the cycle of our lives: joyous first breaths, illness and recovery, and mournful last good byes are all encountered within the four walls of hospitals.

The ACA (Affordable Care Act) is stoking real-life drama in the medical field, with the final provisions of the law coming into effect in 2015. The act will force a transition for healthcare insurers to transform their practices from away from their traditional business-to-business orientation to take on a business-to-consumer relationship with customers (patients). This week we will examine if customer sentiment regarding health insurance more resembles a plucky comedy or a somber Greek tragedy.


To analyze healthcare companies, I used the Clarabridge sentiment score to examine customer sentiment. Clarabridge measures positivity or negativity on an 11 point scale from -5 to +5, 0 being neutral. Health insurance companies overall score a fairly negative sentiment across the board and customers frequently take to online review sites and social media to voice complaints about billing and claims. Kaiser Permanente and HCSC both score the highest in overall sentiment, and both are the only two companies in the study which featured over 30% positive feedback. Although the overall sentiments from health insurance companies specifically are negative, from an insurance industry perspective they are very close to the average. Using Facebook data from the past year and aggregating feedback from 25 insurance companies, I found that the industry has had a small decline in overall performance over the past four quarters.


Although the overall averages are close, health insurance providers saw a sharper drop in customer sentiment compared to providers of other kinds of insurance. This decline in sentiment is an early indicator of some of the challenges health insurance companies face as the entirety of the ACA comes into effect. Because the law requires everyone to possess health insurance and creates a competitive market for insurance, it will shift the nature of healthcare insurance, causing it to become a more customer-focused industry. Furthermore, government regulations add another layer of complexity between offered services and the consumer. With the shadow of ACA looming, healthcare insurance providers need to place an increased emphasis on the customer experience or risk churn. My detailed analysis of customer comments revealed some interesting trends as well as a few key opportunities for improvement.


When examining the top areas of customer feedback, I discovered that the two largest themes by volume are 1) inquiries around covered services, followed by 2) selection of doctors/hospitals. Member service is the lowest-rated theme by sentiment and is mentioned by 23% of all customers. Billing and payment and website performance are almost equally negative which is a surprise considering that issues with payment typically lead to highly critical reactions from consumers.

Improve Website Performance

When comparing the numbers of positive to negative comments, it is clear that website issues are an incredibly salient touchpoint for healthcare insurers. Customers were 232% more likely to leave a negative comment regarding insurance websites than a positive mention.


This high ratio of negative feedback is at the same level to billing and payment issues. Given the importance of this touchpoint to reduce expensive call center contacts and to create high levels of customer experience, website improvements need to be made industry-wide. In fact, healthcare insurers score much lower in sentiment for website usability compared to home and auto insurance companies. This increased negative sentiment is correlated with elevated mentions; in a comparison across over 300 brands on Facebook, health insurance companies average 10% more conversation about website usability. This contrast clearly shows the customer experience edge most home and auto insurers have from their focus on the end customer.


Healthcare insurance customers are also having more trouble finding information compared to auto and life insurance customers. Customers were 56% more likely to mention being unable to find necessary information. The difficulty in finding information bled into sentiment for browsing and navigation, which was dramatically lower for healthcare companies. Technical issues were mentioned 83% more often, and performance related comments 33% more common.


Sample comments [sic]:

Hello, my Incentive Awards program website is not working, keeps giving error when I try to redeem my points.

Your web application keeps crashing.

Resolving the customer experience around website performance may lead to improvement in the two other highly negative topics around healthcare insurance: service quality and billing.

Improve Service Quality

Member service quality was the lowest topic by sentiment. However, complaints were not generally focused on the quality of advice offered. Rather, speed of service, runaround, and dropped calls were the most common and most negative themes by sentiment. This indicates that customer service reps may be well trained but are dealing with high levels of call volume. Improvements to self-service channels like the website could reduce call center contacts, leading to better levels of customer care. Unsurprisingly, Kaiser Permanente had both the highest rated website and the highest rated level of member service by sentiment, contributing to its claim to best overall sentiment.

Sample Comments [sic]:

Was on hold and just as the phone rang thru after 20 minutes on hold, the agent hung up on me.

I spent 1.5 hrs today on hold with customer service before finally giving up and hanging up.

We will get some one to call you back never call me back right now i am on hold with member service for this wait wait i my die before i get any help.

Suggestion: If you do not have enough phone reps to answer calls in a timely fashion, at least offer automatic call back like BCBS and many other companies.

Make Billing Easier Online

One consistent theme in the billing comments that do not pertain to missed or inaccurate claims is the lack of trust and consistency in online bill pay. Customers wish to pay online but find the payment systems unfriendly or broken, leading to additional call center volume. This is made more complex by policies that specify which plans can and cannot be paid over the phone. Given the ease with which most customers use online bill payment systems for banking and online retail, this is a sore point for customer experience.


Sample comments [sic]:

I cannot locate the e-Billing link anywhere either. It was there every time I went to the website last year

What kind of insurance company will not accept a wire transfer from a bank, or credit/debit cards, and does not have ANY cheaper payment options that can be used in an emergency, like a check by phone option??

My monthly ritual: Having a fight over the phone with Kaiser Permanente because their online payment system is down, and they do not accept over the phone payments for Obamacare clients.

trying to pay on line 6-10 x and holding for hours after that does not work..

Online system still has the bug that refuses to accept tick box of “checking” account for electronic payment.

As more health insurance providers begin to see patients as customers, they must do what they can to improve the customer experience. By optimizing their websites, streamlining service quality, and simplifying online bill payment, they will increase customer satisfaction and reduce the drama.


Dheepan Ramanan is a data scientist at Clarabridge. Follow him on Twitter @DheepanRamanan.