Enhance Your Member Experience with a HIPAA-Compliant Healthcare Call Center During Annual Open Enrollment Period

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During the annual open enrollment period, when many people sign up for health plans, the contact center gets a lot of calls. For example, the Center for Medicare and Medicaid Services (CMS) stated that they got 16.3 million calls about health coverage plans during last year’s open enrollment period. With so much information to process, it can be difficult for members to understand and make the best choices for their health plan.

Delivering an exceptional member experience during this period is always challenging. During this busy time, healthcare plan providers need to ensure they can meet the needs of both new and returning customers while meeting the needs of their current customers. However, a HIPAA-compliant healthcare call center can improve the member experience by doubling the contact center workforce to meet the surge in calls while ensuring that all information is kept secure and private. In this blog, find out how you can enhance your members’ experience with a HIPAA-compliant healthcare call center during the annual open enrollment period.

Increased Call Volume During and After Open Enrollment

Many factors contribute to the increased volume of calls, including:

  • Consumers call after the plan selection and enrollment period has ended for questions or assistance.
  • Calls may get extended beyond the period of open enrollment. In that case, plan providers need to schedule separate verification calls to ensure members should get a proper understanding of the plan. In addition, medical insurance plan providers must make three documented, “interactive” attempts to contact the enrollee within 15 calendar days, as mandated by section 70.6 of 42 CFR 4222.2272(b). Automating these calls is prohibited.
  • There is also a spike in calls when Explanation of Benefits (EOB) letters get mailed, which can cause confusion among customers and lead to more calls.

Lastly, new customers who choose new plans often take longer to process than customers who have already signed up but have questions about their coverage. Existing customers are still entitled to the same service level agreements as before.

As a result, the open enrollment period has been unusually complex and unpredictable.

Challenges of Healthcare Plan Provider During Annual Open Enrollment Period

The time of year when people can sign up for health plans is a busy time for providers. They receive many phone calls and emails from members with questions about their benefits, coverage, and options. Also, many members need help figuring out what to do about the changes in the healthcare system and need more information.

Thus, it can be an extremely frustrating time for both members and providers. Providers want to be able to help their members make the best choices for their health and budget, but they get swamped by the sheer volume of inquiries. Here are some challenges to annual open enrollment:

1. High call volume: During open enrollment, providers may get so many calls that they can’t handle them all. In addition to answering phone calls and emails, providers may have to manage social media requests as well.

2. Limited resources: Many health plans need more resources to answer their members’ questions on time. Members may have to wait longer than desired for answers or assistance.

3. Confusing Rules: The rules and regulations governing health insurance can confuse members and providers alike. Providers need to understand how changes in government requirements will affect their plans to serve their members best.

4. Misinformation: When people can sign up for health insurance, there is a lot of false information, especially on social media sites like Facebook and Twitter. Providers must stay up-to-date to give members accurate information and point them to the best places to get help.

5. Strict Deadlines: Enrollment periods are usually short, so providers must move quickly to help people before the deadline. It can make mistakes more likely to occur or be missed if the staff needs to learn how to use the system quickly and correctly.

6. Lack of personalization: Because there are so many questions during the open enrollment period, it can be challenging for providers to give personalized advice and help. Members may feel their needs do not matter and that they are just another number in the system.

7. Technology issues: Providers must make sure that their technology systems are working correctly and that they can store and access member information safely. If there are any glitches or problems with the system, members may be unable to enroll or make changes to their plans.

The annual open enrollment period can be overwhelming and stressful for members and providers. Providers need to be ready to handle many questions, give accurate answers, and meet tight deadlines so that their members can make intelligent decisions about their health insurance.

Steps for Delivering a Great Member Experience During Open Enrollment

The open enrollment period for health insurance is critical for members and insurers. Providing a great member experience during this time can significantly affect how happy members are and how long they stay with the organization. Here are some actions you can bring to ensure a great member experience during open enrollment:

1. Make sure your call center has everything it needs. That means having enough people on hand to handle the higher volume of calls and making sure those people know everything there is to know about your products and services.

2. Communicate early and often with members about open enrollment. Send reminders about the deadlines, and let them comprehend how to reach you if they have any questions.

3. Be available and responsive when members do contact you. It means answering their questions thoroughly and on time.

4. Follow up after the open enrollment period to make sure everything went smoothly for members. Ask them for feedback on their experience, and use that feedback to improve your process for next year.

5. Provide helpful resources on your website. Make sure members have access to tools and information to assist them in making informed decisions about their health insurance options.

Doing these things can give your members a tremendous open enrollment experience and keep them involved with your organization for the long term.


A healthcare call center that is HIPAA-compliant is a great way to improve the member experience during annual open enrollment periods. By providing a secure, efficient, and reliable platform that members can use to make their health insurance decisions quickly, accurately, and securely, customers can feel confident that the highest privacy and security standards are protecting their medical information. In addition, with highly trained staff on hand to answer any questions or concerns about plans and coverage on time, customers can rest easy knowing they have all the information they need at their fingertips when making important healthcare decisions.