Why Are Healthcare Members Still Getting Surprise Bills?

Healthcare members are incurring unexpected out-of-pocket charges because critical plan updates are obscured within undifferentiated notifications. The issue is widespread: millions receive high volumes of generic messages about benefit changes that fail to highlight coverage-relevant details. Many U.S. adults report dissatisfaction with healthcare costs, a figure influenced in part by the complexity and volume of benefits communications.

Most healthcare providers still send the same message to every member. It doesn't matter if you're diabetic, have heart problems, or are perfectly healthy. Everyone gets identical notifications about plan changes. During benefit renewal periods, members receive dozens of these generic messages that convey little useful information about their specific situation. Recent research shows that 4 out of 5 consumers believe adherence to their communication preferences would enhance their overall satisfaction with their health plans.

Members miss critical updates about their benefits. This leads to billing disputes and fewer people using preventive care programs. Healthcare transparency regulations, including the No Surprises Act and Transparency in Coverage Rule, demand more personalised communication, but most organisations still operate like it's 1995. They send mass mailings and hope for the best.

Healthcare systems nationwide face the same problem. How do you cut through the noise and tell members what they need to know? Generic mailings create confusion. Manual processes can't handle the volume of plan changes and regulatory updates that need communication.

To address this gap, working with a leading U.S. healthcare payer, Haritha Murari designed the Target Messaging Application (TMA). Rather than broadcasting generic notifications, TMA generates individualised communications by integrating each member’s medical history and plan data. The system analyses healthcare utilisation patterns, medication profiles, and benefit usage to deliver targeted messages about plan updates, renewals, and relevant services aligned to the member’s specific needs. TMA was designed to align with HIPAA privacy safeguards, including PHI protections, business associate agreements with vendors, and member opt-out options.

How the system works

Her system connects multiple healthcare databases. It pulls information from claims processing, electronic health records, and benefit management platforms. Then it matches relevant plan changes with individual member profiles. The system creates personalised Explanation of Benefits documents that show each person the information they care about most.

A diabetic member gets detailed notifications about medication coverage changes. Someone with no chronic conditions gets messages about wellness programs. The system tracks how people respond and sends follow-up messages through their preferred communication channels.

"I watched members get hit with coverage changes they never saw coming because their notifications looked like junk mail," Haritha Murari says. "We had all this data about their medical history and plan details, but we weren't using it to help them understand what changes meant for them."

What happened next

The Target Messaging Application sends a high volume of automated notifications each year. Each one is tailored to the person's medical history and current plan details. In her experience, member engagement improved significantly because people started responding to messages that actually applied to their healthcare situation. The system reduced manual notification work substantially, which freed staff to handle complex member questions instead of stuffing envelopes.

This matters because healthcare organisations need to improve communication while controlling costs. Thehealthcare automation market reached $37.71 billion in 2024 and keeps growing as more organisations adopt systems that help rather than replace human interaction.

"The change was instant," Haritha Murari explains. "Instead of complaints about surprise bills, we got calls from members thanking us for warning them about coverage changes. From my perspective, they felt like we understood their healthcare needs."

The bigger picture

Her work shows how the healthcare industry is changing its communication approach. Organisations are moving from one-size-fits-all messaging to personalised outreach. This shift comes from regulatory requirements for transparency and member demands for useful information. Healthcare automation investments keep growing as organisations see automation as a way to build better relationships with members through relevant, timely information.

Healthcare transparency rules require detailed explanations of benefits, but generic documents often make things more confusing. Personalised messaging systems meet compliance requirements while helping members understand their coverage.

Other healthcare organisations are copying this approach to member communication. They're not using automation just to cut costs. They're using it to create helpful interactions that meet both regulatory requirements and member needs.

Artificial intelligence and machine learning will make healthcare communication systems even more personalised. Future systems like her Target Messaging Application will likely predict member needs before problems happen. This could reduce surprise billing and improve healthcare outcomes through better engagement.

Personalised healthcare communication means more than better technology. It shows a basic change in how healthcare organisations think about their relationships with members. Instead of treating communication like a legal requirement, smart systems designers like Haritha Murari use data and automation to create interactions that help people understand their healthcare coverage.