Insiders Reach Out: Insurance Pros Use a Subreddit to Give Back
Moderators use their experience in the health insurance industry to help confused insurance customers.
Personal experience fighting his insurance company for coverage of his own diagnosis and treatment of a rare form of epilepsy led one man to go to work for an insurance company and later leverage the giant social network Reddit to donate his knowledge to a group that helps people cope with insurance companies. Jeremy (who requested a pseudonym for personal reasons) is now a 33-year-old employee of a mid-size midwestern health system with its own insurance plans akin to Kaiser Permanente, and he spends hours each week answering people’s questions about insurance on Reddit. He said in his work that he’s appalled by “how many people unknowingly made a mistake that costs them money, time, energy, effort, and grief.” All of the costly errors being made just because people who were unable to understand the confusing and esoteric language of insurance policies motivated him to try to find a way to help with this problem in any way that he could. That is how he found, joined, and became one of three moderators of the Health Insurance subreddit.
According to the US Census Bureau, 91.4% of people in the United States have some sort of health insurance coverage through roughly 1,000 private health insurance companies. Each company has its own set of plans, which means that it is incredibly difficult to decide which insurance plan to choose because they all have different procedures and appointments to cover.
According to Forbes, Americans estimate they lose over $100 each month due to confusion over their health plan coverage or costs, which tends to add up over the years and can be make-or-break for many Americans.
Reddit’s 48 million users participate in subgroups called subreddits that focus on particular topics. The health insurance subreddit, which was founded in 2008, is described as a place where people confused about health insurance can get help navigating their puzzles. The subreddit, the only one in its space on Reddit, has over 20,000 members and averages roughly ten posts each day, each with seven comments. Posts range from asking about specific healthcare plans’ coverage to asking for advice about what type of health insurance to get. There are nine categories that a user can use on a post, which include individual/marketplace insurance, plan choice suggestions, plan benefits, Medicare/Medicaid, employer insurance, claims/providers, prescription drug benefits, industry career questions, and HIPAA privacy, which allows for visitors to the Reddit to filter for any of their specific questions.
The subreddit is particularly powerful because its three moderators are industry professionals who are able to provide accurate and actionable advice. Jeremy says the moderators “are frustrated with the limits of what we can do in our professional life, so we volunteered our time, in our personal life.” Jeremy himself focuses on complex cases, such as when someone with multiple health issues has overlapping care. For example, Jeremy currently is working with a patient who is a carrier of the mutated BRCA1 gene, which dramatically increases a woman’s risk of breast and ovarian cancer. He has used his experience to work with the woman’s health insurance carrier to pay for the genetic testing, the consultation, and then the total removal of both breasts. According to Jeremy, one of the most time-consuming parts of cases like this one is obtaining a retroactive referral to proceed in a timely manner while also checking off the boxes insurance companies need to proceed with payment. While this is something that Jeremy does often through his work with the subreddit, he said he’s frustrated that insurance companies leave patients to manage piles of complex paperwork themselves. When patients seek help from carriers, they are often shunted to low-skill call center workers rather than industry professionals who are well-versed in insurance claims and policy. How questions are coped with in the subreddit depends on the topic’s complexity. If a question is simple or one-off, it is handled in the comments. Complex cases are handled either through e-mail or over the phone, especially when attachments or long explanations are required.
Because moderators work for health insurance companies, they agreed with each other to never engage in any solicitation. That, however, does not preclude them from recommending or discouraging certain plans, since some plans are still not compliant with the Affordable Care Act, which bans insurance companies from refusing to cover pre-existing conditions. The moderators have a system in place to prevent any sort of self-dealing by first recommending public health care plans if the user is eligible, the plan will cover most of the patient’s expenses, and if open enrollment is available. Then they refer people to low-cost federal health centers and charitable hospitals before finally jumping to private insurance. They also encourage people to file network advocacy appeals with their state insurance commission if their network does not include necessary doctors.
The moderators all know each other well and consult each other on confusing cases. While people posting questions will often be one-time users, those with complex cases will often stay in the Reddit and contribute their two cents or ask follow-up questions. In addition, health insurance professionals who do not have the time to be moderators sometimes also contribute on an ad hoc basis.
Insurance can be an emotional mine field. While the community tries their hardest to help, interactions are sometimes less than amicable. For example, once an individual was asking for advice about top surgery, but they did not have Medicaid and hadn’t enrolled in ACA insurance. However, this individual kept insisting that a plan would cover them and became belligerent and argumentative to the point that they had to be banned. Jeremy says he understands the reaction because it concerns their money and their life-changing treatments. The vast majority of user bans tend to be insurance companies promoting their plans.
Looking ahead, Jeremy sees the community’s mission staying unchanged. Beyond helping individuals, he says the group achieves another important result. The moderators contributing their time help people understand that people who work in health insurance “really are real humans on the other end of the phone or in the building who are working to do everything we can to get people the benefits you deserve.”
