Rebuilding member trust starts with AI-powered support

It’s  7:30 p.m. Clara is standing in her kitchen, holding a prescription and a benefits letter. Her doctor has just changed her medication, and she’s not sure if the new one is covered.  

She tries to call the health plan’s member services line- but it’s after hours. She searches through the portal, but it’s confusing. She’s not even sure she has the right login. 

Frustrated and unsure, she gives up. She decides to pay out of pocket. It’s $118. She doesn’t want to, but she doesn’t feel like she has a choice. 

And she’s not the only one.  

For the health plans, moments like this quietly erode trust, drive dissatisfaction, and over time lead to churn. Not because of benefits. But because the member didn’t feel supported when they needed it most. 

 Support delayed is trust denied.

We’ve spent years improving plan design, outreach, and member services. 
But when seniors can’t get a clear answer at the moment, they need help, the rest doesn’t matter. 

Every time a member pays out of pocket because they couldn’t get support or skips a visit because they didn’t understand what was covered, they lose confidence- in the plan, in the experience, and in the relationship. 

And for health plan leaders focused on growth and retention, these pain points aren’t abstract. They show up months later in disenrollments, low satisfaction scores, stagnant enrollments, and reputation challenges. 

How AI can bridge the gap 

AI-powered virtual assistants now make it possible to support members around the clock, without asking them to jump through hoops or wait on hold. 

These assistants can: 

• Understand and respond to members’ questions about coverage 

• Scan and explain benefits documents in simple language 

• Guide members through copays, providers, prescription coverage, and next steps 

• Speak to members in their language 

They don’t replace your service team. They assist them- by handling the everyday questions and situations that would otherwise slip through the cracks. 

The hidden advantage of better engagement 

When members feel supported, it impacts everything else. 

• Higher member satisfaction 

• Increased enrollment 

• More referrals 

• Improved 90-day retention 

• Lower churn 

• Higher CAHPS scores 

Members don’t leave because of their coverage. 
They leave because they felt ignored. 

And the technology to solve it is already here. 

Quietly. Reliably. At scale. 

Let’s put it to work.

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