Shopping Assistance
2 min read
Guide members through the healthcare shopping process and help them find appropriate care options. This comprehensive guide covers common shopping challenges, proven troubleshooting techniques, and step-by-step solutions for the most frequent issues.
Shopping Support Focus
Help members navigate healthcare shopping challenges with proven solutions for search issues, pricing confusion, provider selection, and appointment booking problems. Your role is to empower members to make informed healthcare decisions while providing excellent support throughout their shopping journey.
Search Problems
Members can't find providers or procedures, searches return no results, or filtering isn't working properly.
- Try broader search terms
- Check spelling
- Verify location settings
- Use alternative procedure names
Pricing Confusion
Unclear cost estimates, confusing insurance terms, or unexpected pricing differences between providers.
- Explain deductibles and copays
- Clarify in-network vs out-of-network costs
- Review member's specific plan benefits
Provider Selection
Difficulty choosing between providers, understanding quality ratings, or finding specialists.
- Explain ProScore ratings
- Help compare provider credentials
- Guide them through quality indicators
Step-by-Step Resolution Process
Standard Shopping Support Workflow
1
Listen and Understand
Let the member explain their shopping challenge completely before jumping to solutions. Ask "What exactly are you trying to find?" to clarify their healthcare need.
2
Verify Member Information
Confirm insurance plan details, location, and any specific provider preferences. Check if they're looking in the right geographic area and network.
3
Replicate the Search
Use your dashboard to perform the same search the member is trying. Use member impersonation to see exactly what they're seeing.
4
Provide Guided Assistance
Walk them through the correct search process step-by-step. Stay on the line while they perform the search to ensure success.
5
Confirm Resolution
Verify the member can complete their healthcare shopping successfully. Ask them to bookmark the provider or save the search results for future reference.
Common Scenarios & Solutions
"I'm searching for a dermatologist near me but nothing comes up."
Example:
Solution: Try "skin doctor" instead, expand the search radius, check if they're in a rural area with limited providers, or verify their insurance network includes dermatology.
"This procedure costs $500 but I thought my insurance covered everything."
Example:
Solution: Explain their deductible hasn't been met, show how copays work, or help them find in-network alternatives. Clarify the difference between covered services and out-of-pocket costs.
"There are 10 doctors nearby. How do I know which one is best?"
Example:
Solution: Explain ProScore ratings, point out quality indicators, help them compare credentials and specializations, and suggest reading patient reviews if available.
| Problem Type | Common Causes | Quick Resolution |
|---|
| Search Issues | Misspelled terms, too specific search, location problems | Try broader terms, check spelling, verify zip code |
| Pricing Questions | Deductible confusion, network misunderstanding | Explain benefits structure, show network status |
| Provider Info | Outdated information, limited details | Cross-reference with provider websites |
When to Escalate
Escalate shopping issues to higher tiers when you encounter:
- System-wide search problems affecting multiple members
- Insurance verification questions beyond basic network status
- Provider credential concerns or safety issues
- Complex medical situations requiring care coordination
