Health Insurance Call Centers: The Challenge of Getting Consumers to the Right Place

by John Hansen

With Varying Products and Consumer Types, Getting Callers to the Right Place Can Be Difficult

Obama Care California and the new world of the Affordable Care Act (ACA) has made it difficult for health insurance call centers to get people to the right place when they call for support. Clients are eligible for or enrolled on various products. Offerings include individual coverage, group health insurance, Medi-Cal, Covered California, and direct to carrier enrollment.

A particularly complicated client may call in and say, “I’m on a group health plan through work, my pregnant wife is on AIM (Access for Infants and Mothers), my older daughter has a Covered California plan, and my kids are on Medi-Cal. I’ve had an income change, so who do I talk to about that?” To which the caller will likely hear a moment of silence on the other end of the line as the rep tries to take all this in and figure out who the client should contact first. Likely, this client is going to have to make multiple calls.

New Sales and Existing Members

Agents working jobs at health insurance call centers realize that consumers who are looking to apply and members who are already enrolled on a health plan have very different service needs.

  • New Sales: These clients need information about pricing, benefits and enrollment. They may have questions about the California Health Exchange and whether or not they qualify for government assistance up-front tax credits.
  • Existing Members: These clients may need assistance with claims, billing, or maybe they want to switch plans. If they are considering switching plans, they may need similar information to consumers who are looking to enroll.

Customers Calling the Wrong Phone Numbers

Blue Shield of California says that half of the calls to their direct sales health insurance call centers are member calls. This means that 50% of the calls they receive begin with clients calling the wrong number or selecting the wrong options on the voice prompts.

Why would this be? Sometimes people press the wrong number. Sometimes they don’t have the right phone number, so they just call any number they can find. Also, people tend to think they’ll get faster service if they go to sales rather than selecting member services. They expect the company to service new sales better than existing members. Whether that’s true or not, that’s often the perception.

Getting Callers to the Right Company or Department

For reps at these health care call centers, often their first job when they get a client on the phone is to get them to the right department or even the right organization. They may need the Covered California phone number. They may need to contact Medi-Cal, or they may need to connect with a certain department at the health plan.

Very different products and support are offered at these health insurance call centers. Not all agents service all products and all insurance needs. Often reps who answer the phones specialize in one of the following areas:

  • Individual and family
  • Small business
  • Medicare
  • Life insurance
  • Medi-Cal
  • Dental
  • Vision

With lots of different products and service needs, agents working at health insurance call center jobs often need to specialize. This allows support staff to offer specialized expertise. Then, if you get the right person on the phone, they really can help you.


Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.

Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.

Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.