sensavera
Session insights
Your member's voice, our analysis
Here's what we extracted from your member's conversation — the patterns, the connections, and the insights that will help improve the member experience.
Summary
What we heard
This member gave Horizon an 8 but feels unsupported after enrollment. She lacks confidence in specific
coverage details — like a $35 strep test charge she can't explain — and received no educational
materials or welcome info to help her navigate. Finding specialists is overwhelming due to hundreds of
undifferentiated options in the directory.
Experience map
How the insights connect
Each node represents a concept, touchpoint, or outcome extracted from your conversation. The connections show
causal relationships — what compounds what, where problems manifest, and what outcomes they produce.
Concept
Touchpoint
Outcome
compounds
leads to
manifests at
produces
Conversation
Exchange by exchange
Each exchange shows the question asked, the member's response, and the AI's reflection — along with the concepts
extracted from what was shared.
1
Plan Understanding
How likely are you to recommend Horizon to a friend or colleague?
8
You'd put Horizon at an 8 out of 10.
2
Plan Understanding
Follow-up
What's the main thing that keeps it from being a 9 or 10 for you?
Being a nine or 10 means you have to go above and
beyond. Every single time I need help. And while Horizon is good at helping, they meet my expectations. They don't go above and beyond.
So for you, a 9 or 10 means consistently going above and beyond — and while
Horizon gets the job done and meets your expectations, that extra step hasn't been there.
Expectations met, not exceeded
3
Coverage Confidence
How confident do you feel about understanding what your plan covers and what it
doesn't?
I understand that basic things are covered, but when it gets to more specific
questions, I don't feel confident. For example, if I take my daughter to the
pediatrician because her throat is hurting, they always charge me an extra $35 for
the strep test. Is that because it's not covered? Is that because I have an extra co-pay for strep
test? If I log on to the portal or the app, I can't find coverage for strep
throat test. It doesn't get that specific. So I have to assume that the doctor already knows what's covered
in my plan or not because I have no way of finding out unless I'm calling the health
insurance company in the middle of a doctor's office visit.
The basics feel clear, but the specifics trip you up. That $35 charge at the
pediatrician is a perfect example — you can't tell if it's because the strep test isn't covered or if it's
just a separate co-pay. You looked in the app and on the portal and couldn't find that level of detail.
Coverage transparency gap
Self-service failure
4
Care Access Readiness
When you think about getting care — seeing a doctor or finding a specialist —
how prepared do you feel to navigate that?
When it comes to seeing a doctor, I'm okay because typically I already know
what I need to see the doctor for. When it comes to finding a specialist, that's
really always very challenging. And the reason for that is because I don't know which specialist to
go to. I may know that I need to see for example, an ENT doctor. But there are hundreds of ENT doctors in the directory and I don't know which one is gonna give
me the best experience or treat me for what I want. I actually went to a podiatrist
once who misdiagnosed me, and if I hadn't gone to another one, I would never have known that I was
taking medication for something that I didn't need to. And that could have harmed my internal organs. So
being able to trust that you're finding the right provider and selecting the right one is extremely
important.
Finding a specialist feels really different from seeing a regular doctor for
you. You know what kind of specialist you need — like an ENT — but facing hundreds of options with no way to
know who's actually good is overwhelming. And that podiatrist experience makes it concrete: a wrong choice
led to a misdiagnosis and medication you didn't need.
Specialist finding difficulty
Directory overwhelm
Quality signal absence
5
Onboarding Experience
Looking back at your first few months as a member, how was the process of
getting set up and oriented?
Beyond selecting the plan that I chose for the year, there really hasn't been a process of getting set up and oriented. Horizon just assumes that I
know my plan, I haven't received any educational material or welcome
information to help me navigate the plan at all.
So after joining, it was really just silence — no materials, no information
to help you find your way around the plan. It sounds like Horizon left you to figure it out on your own.
Onboarding gap
Analysis
Key insights
Three patterns emerged from this conversation that connect to broader themes across the member experience.
Coverage information fails at the point of care
The plan's digital tools (portal and app) provide general benefit information but
can't answer specific questions about what a particular service will cost. This forces members into a
lose-lose situation: call the insurance company during a doctor visit, or absorb unexpected charges and hope
for the best, like a $35 strep test.
Concepts: Coverage transparency gap → Self-service failure → Portal/app
The provider directory creates risk, not confidence
Hundreds of undifferentiated specialists with no quality signals, ratings, or patient
feedback. The directory provides quantity without quality information, which led directly to a harmful
outcome. The member has learned to distrust the
directory entirely.
Concepts: Directory overwhelm → Quality signal absence → Specialist finding
difficulty
Zero onboarding compounds every other problem
No welcome materials, no orientation, no education. The member was left to discover
how her plan works through trial, error, and unexpected bills. This onboarding gap is the root cause that
amplifies both the coverage confusion and the provider discovery challenge — with orientation, both could be
less severe.
Concepts: Onboarding gap → Coverage transparency gap + Directory overwhelm
Recommendations
What this means
Three actions this conversation supports
1
Build a real-time coverage lookup tool that answers specific
questions ("Is a strep test covered? What will it cost me?") — not general benefit summaries.
2
Add quality signals to the provider directory — ratings, patient
reviews, specialty detail, and whether they're accepting new patients.
3
Redesign new member onboarding with a simple orientation that
explains how to use the plan, how to find providers, and what to do when you have questions.