Research Goals
Determine most important and frequent tasks users want to complete when using a health insurance product
Identify pain points / points of friction that users currently experience with health insurance products
Gauge overall satisfaction / dissatisfaction users feel towards current health insurance products
Survey Results
Overview
Health insurance is generally perceived as complex and users want simpler access to clear information on benefits, coverage, and costs
Although digital resources are utilized, users are still calling for support and have a preference for this when they have specific questions they want a human to answer
There's both interest and caution in utilizing AI on digital health platforms – welcomed for things like quickly finding information, but significant concerns exist regarding privacy, accuracy, and whether that would limit connecting with human support.
Pain Points
Inability to estimate cost of services beforehand
Understanding health insurance benefits
Finding information regarding their coverage
User needs
Find coverage details
View health plan benefits (including insurance ID)
Find in-network providers
Estimate the cost of a procedure or service
Notable Experiences
of users didn’t know how much was covered for a specific service or procedure before it was performed
of users experienced difficulty understanding health insurance terminology
of users reported waiting a long time for support or getting disconnected
User Interview Participants
Greg
Age: 64 years oldOccupation: Audio EngineerHealth Needs/Experiences: Ongoing orthopedic needs (particularly for his back) – requires specialist visits, previous procedures, and physical therapy
Anna
Age: 37 years oldOccupation: Mental Health TherapistHealth Needs/Experiences: Therapy for complex ptsd
Max
Age: 38 years oldOccupation: Software Engineering ManagerHealth Needs/Experiences: Previous stroke and current back injury – requires X-rays, CT scans, and physical therapy
Interview Script
Opening
Thank you for your interest in participating in this research. The purpose of this research is to gather information regarding how people interact with health insurance digital resources (e.g. apps and websites), as well as their overall perceptions about them.
My hope is to be able to use this research to inform my designs of creating better digital experiences for people when engaging with their health insurance.
I want to let you know your responses to these questions will remain confidential and will only be analyzed in aggregate. Your individual identity will not be linked to your answers in any reports or publications.
With that said, if you do not understand a question, if it is not applicable to you, or you don’t wish to answer, feel free to just let me know. You don’t have to answer anything you aren’t comfortable talking about.
Questions
- Please state your name 1.
- How often would you say you interact with a health insurance digital resource such as a website or app (i.e. rarely, occasionally, never, often)? 2.
Users who use digital resources
Users who said they use digital resources at least occasionally were primarily asked these questions Scenario: you need to access your health insurance information (it can be any specific detail or task you need to accomplish); How do you go about that? How easy or difficult is it to do that? Where do you find yourself seeking or accessing your health insurance information? What don't you like about any tools you use to manage your health insurance? Why? Imagine the perfect health insurance app. What are the most important things it absolutely must do for you? Why? What are some of the biggest frustrations or challenges you have when dealing with your health insurance? Not specific to a website or app, but generally. Are there currently any specific tasks related to your health insurance that you find particularly time-consuming, confusing, or are overall hard to do? How easy or difficult is it for you to find or access your health insurance coverage or benefits? Do you think that information is explained clearly? What kind of information about your health insurance do you wish was easier to find or understand? Are there any resources or tools within a health insurance app that you would find valuable? How do you typically choose a doctor or find service within your network? What information is most important to you when searching? How do you currently keep track of your benefits, claims, and medications, or other health insurance records, health savings accounts, etc.? What works well and what doesn't? Have you ever had to deal with a denied claim? Can you tell me about that experience? How was it resolved (or not)? Imagine you need to find out if a specific procedure is covered by your plan and if so, schedule the service. What steps would you take to do this today? How easy or difficult is this process? (If they have dependents) How easy or difficult is it to access specific health insurance info for dependents on your health insurance plan? How important is "transparency" in healthcare costs and insurance coverage to you? Do you have access to this information now? If so, describe that experience – how accurate do you find it? How interested would you be in having AI features within your health insurance app or website? Are there specific areas you would welcome AI features and areas you wouldn’t? How would you prefer to communicate with your health insurance provider? If you could change one thing about how you interact with your health insurance, what would it be and why? Not specific to a website or app, but generally. If you had a magic wand and could create any future feature for a health insurance app, what would it be? This can be something that exists now, or maybe something you can see existing in the future. Is there anything else you want to mention, or do you think there was anything I missed you want to talk about?
Users who don’t use digital resources
Users who said they don't use (or rarely use) digital resources were primarily asked these questions What are the main reasons you don't currently use (or rarely use) your provider's website or app? Scenario: you need to access your health insurance information; How do you go about that? How easy or difficult is it to find that information? Where do you find yourself seeking or accessing your health insurance information? What are some of the biggest frustrations or challenges you have when dealing with your health insurance? Are there currently any specific tasks related to your health insurance that you find particularly time-consuming, confusing, or are overall hard to do? How easy or difficult is it for you to find or access your health insurance coverage or benefits? Do you think that information explained clearly? What kind of information about your health insurance do you wish was easier to find or understand? Are there any resources or tools within a health insurance app that you would find valuable? How do you typically choose a doctor or find service within your network? What information is most important to you when searching? How do you currently keep track of your benefits, claims, and medications, or other health insurance records? What works well and what doesn't? Have you ever had to deal with a denied claim? Can you tell me about that experience? How was it resolved (or not)? Imagine you need to find out if a specific medical procedure covered by your plan and if so, schedule the service. What steps would you take to do this today? How easy or difficult is this process? (If they have dependents) How easy or difficult is it to access specific health insurance info for dependents on your health insurance plan? How important is "transparency" in healthcare costs and coverage to you? Do you have access to this information now? If yes, describe that experience – how accurate do you find it? If you could change one thing about how you interact with your health insurance, what would it be and why? Is there anything else you want to mention, or do you think there was anything I missed you want to talk about?
Themes and Insights
Key Themes
- Users struggle to understand insurance terminology and benefits without the context of how it relates to their unique plans (e.g. co-insurance percentages are different across individuals’ plans)
- Users desire a quick way to see what their plan covers (e.g. procedures, prescriptions, labs, etc.) and to easily understand the specifics like copays, co-insurance, and deductible status — especially at the time it is needed (e.g. tests that arise during a doctor's visit)
- Users overwhelmingly want to know the cost of specific services or procedures before receiving them (e.g. MRIs, tests at urgent care, etc.)
- Transparency of health insurance costs is naturally related to users’ need to reference the specifics of their coverage – they want it clearly explained what their out-of-pocket responsibility is going to be
- This information is either unavailable or not readily available to users through digital tools — some users don’t even find calling their insurance a reliable for clear cost estimates
- Users overall found the experience of managing health insurance and personal records difficult and fragmented — information and necessary tasks were scattered across multiple sources (e.g. their insurance app/website, provider portals, financial accounts like FSA/HSA).
- There's a lack of centralized organization for users' health history, and they resort to workarounds and manual effort (e.g. file management and email folders)
- Users want easy access to their health history (e.g. lab results, imaging, and vaccination records)
- Tracking claims within health insurance products is either difficult, not utilized, or does not exist — some users rely on paper mail or external sources like their FSA/HSA account
- One of the major tasks users perform is finding doctors/specialists covered by their plan — they're often looking for specific information like location, specialty, or gender, as well as reviews and availability
- Users emphasized that detailed provider information (availability, specialties, reviews, proximity, etc.) within their health insurance products was currently lacking
- Related to the issue of fragmented systems, users frequently reported that scheduling appointments directly through their insurance portal/app was difficult, inefficient, or most often, simply unavailable — so users have to take manual steps to accomplish this task (e.g., calling their insurer, getting a list sent via email, or booking on provider websites).
User Personas
Sarah Chen
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Eric Miller
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User Journeys
I mapped the end-to-end experience for Sarah and Eric to pinpoint exactly where they abandon the digital product and resort to manual workarounds.
Journey 1
The Records Scavenger Hunt
User: Sarah (The Family Manager)
Goal: Sarah wants to locate, confirm, save, and submit her daughter’s vaccination records required for kindergarten registration.
The Breakdown: Sarah’s journey revealed a chaotic manual process. To submit school forms, she had to physically sift through filing cabinets, scan paper documents at home, and merge files manually.
The Opportunity: Centralized Digital Records. A feature to upload, store, and verify physical records so users never have to "scavenge" again.
Journey 2
The Dead End Search
User: Eric (The "Just Basics" User)
Goal: Eric wants to look up how much a strep throat test is going to cost him.
The Breakdown: Eric tried to self-serve by searching "strep test cost," but the app failed to understand the query. He was forced to abandon the app and wait on hold with Member Services just to get a price.
The Opportunity: Smart Cost Estimation. A tool that understands natural language (e.g., "Strep Throat") and calculates out-of-pocket costs based on real-time deductible status.
Summary of Findings
Users primarily interact with their health insurance in order to find in-network providers, understand coverage and costs, and access their insurance benefits information. However, they consistently experience friction directly related to those tasks such as inefficient provider search and scheduling, a significant lack of cost transparency, complex and hard to find insurance jargon.
Users are also frustrated with poor or inexistent search functionality within their insurance products and the way their health information is often scattered across multiple sources, which makes it hard to manage.
Users frequently must resort to time-consuming phone calls or manual workarounds taken outside their health insurance products to accomplish tasks like researching providers.
Due to these challenges, users are overall mostly dissatisfied with their current health insurance digital products — they find them inadequate in providing a clear, efficient, and centralized health management experience.
Ultimately, in a nutshell, what I found is that users desire a simple, transparent, and integrated platform to manage their health insurance needs with ease.
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User Research Report