Why Employer Health Plans Need Built-In Care Navigation
The status quo: call center fatigue
58% of insured adults ran into a real problem with their coverage last year: a denied claim, a network gap, a stalled prior authorization.¹ Call for help and it's a phone menu, a hold queue, and an agent whose job is to end the call, not necessarily fix the problem.
Often, it doesn't get fixed. Nearly half of those problems never get resolved to the individual’s satisfaction. Three in ten people just give up.¹ It's not only that people can't get answers. They don't feel like anyone's actually listening. "Emotional connection" is the lowest-scoring dimension in the entire health insurance call center industry, and not one health insurer rates well on it.² Only 30% of health plan members call their plan a trusted partner.³
None of that stays contained. More than 1 in 5 employees who hit a problem with their insurance end up bringing it to HR instead.¹ That means unnecessary delays in employees’ care, less time employers spend running their business, and more time brokers spend resolving escalations.
Arlo's philosophy: built-in care navigation
Getting help from your health plan shouldn't be this hard, and we think that's a design failure. Most support models are built to end the call quickly. Ours is built differently: to give employees a dedicated team that makes them feel heard and stays with them until their needs are actually resolved.
Other plans offer this as a buy-up, or require a separate navigation service that can cost $10 to $15 per employee per month.⁴ We've built it directly into every Arlo plan, because we believe support like this should be standard, not a premium add-on.
How Arlo’s care navigation works
Every employee has a team of Member Advocates behind them. They can reach the team however's easiest: message in the app, text (844) 440-3968, or email support@joinarlo.com. During business hours (8am–5pm CT), they'll hear back in under 3 minutes by text or app, or within 15 minutes by email.
The goal is more than fast answers. It’s equipping each member with a team that knows their benefits and needs inside and out—available on demand. The team works with employees through each step of their care journey, offering personalized guidance and support that builds real confidence in their health care decisions.
Getting started with Arlo
Most carriers leave employees to transition ongoing care onto their plan alone.
With Arlo, employees can send us a list of their medications, their preferred pharmacy, and any current doctors they’re seeing. We confirm everything is covered and in-network before day 1. We’ll even let them know if they’re eligible for prescription savings programs, and help them enroll.
If prescriptions need a prior authorization, or employees have an upcoming procedure that requires a pre-cert, our team works with their providers to expedite submissions so care goes uninterrupted.
Navigating everyday care
Most plans hand employees a directory and leave the rest to them.
Arlo’s Member Advocates work directly with employees to find the right doctor or specialist, explain what's covered and what something will cost, and book their appointment for them. Our team uses provider quality scores and pharmacy data to steer employees toward better, lower-cost options, $0 virtual urgent care visit when appropriate, or a prescription savings program.
Working through problems
Most call centers give employees the runaround, leaving them to resolve insurance issues alone.
If something unexpected happens, like an EOB that doesn’t look as expected, a prior authorization that was denied, or a lost ID card, employees can get a Member Advocate’s help to investigate and check for errors, coordinate on their behalf with providers and other third parties to get them resolved if needed, and get the the clarity they deserve.
What we've seen
- ~95% employee satisfaction with the care navigation experience
- 99% adherence to our under-3-minute response SLA
- 100% of savings achieved through care navigation are passed through to employers via surplus return
"As always, I think you guys are the best! I really like just texting and getting a response. Thank you for everything that you do." (Arlo Member)
Most people don't feel that kind of partnership with their health plan.³ Arlo's numbers show what's possible when the model is actually built around the relationship, not the call length.
What this means for you
If you're an employer: we handle the insurance problems that would otherwise land on HR's desk before they ever get there. The savings show up directly in your surplus return, too.
If you're a broker: we give you something real to bring into a renewal conversation besides price. A model built on service as retention, not just cost as retention, is easier to defend when a client asks "why Arlo."
See it for yourself
Want to see how this works for your team or clients?
- Employers: ask your Benefits Broker about Arlo, or reach out to us directly—learn how you can offer a better experience to your employees through Arlo’s built-in Care Navigation.
- Brokers: reach out to Arlo to bring a modern, differentiated health plan and offering to your clients. Ask for resources on our Care Navigation service, including real case studies.
Sources:
- KFF, Survey of Consumer Experiences with Health Insurance (2023)
- Qualtrics XM Institute, The State of CX in the Health Insurance Industry (2023)
- JD Power, 2026 U.S. Commercial Member Health Plan Study
- The Health Management Academy, "Transcarent launches AI-powered clinical navigation platform"
