Even in a well-run system it happens: a colleague lands at HR saying „this insurance doesn’t work". Most such cases resolve in 5 minutes – if you know which type you are facing.
Type 1: „I don’t know who to call"
The most common and the easiest: the colleague called the insurer’s main line and got lost. Solution: the care coordinator’s dedicated number – it is on the one-page summary, and HR should keep it handy too. Prevention: the number everywhere.
Type 2: „No appointment within a reasonable time"
Ask: did they insist on one specific clinic, or did the coordinator offer everything? Another town, another partner often has slots within days. If network capacity is genuinely tight in that specialty, that is valuable feedback – collect such cases, they are arguments at renewal (article).
Type 3: „They said it’s not in my package"
Clarify first: is it truly not included (a tier matter) or a misunderstanding (wrong service name)? The one-page summary plus the coordinator’s cover check settles it. If a seemingly legitimate claim was rejected, that is our table: stuck cases.
Type 4: „I paid but they won’t reimburse"
With reimbursement elements the three typical causes: the invoice is not in the insured’s name, medical documentation is missing, or submission was past deadline. The first two are fixable – review the submitted pack together before escalating.
When should HR escalate to us?
When the same blockage type repeats (suspected systemic issue), when a legitimate claim is disputed, or when the coordinator’s commitments keep slipping. A short e-mail with the case outline – and we take it. HR’s job is to flag, not to fight.
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