Three Doors
Every "no" arrives with its reason in plain language and three doors forward.
The job
Explains every decision that goes against someone (a rejection, refusal, fine or split of liability) in plain language, with three concrete next steps. It then proves the explanation reduced anger, repeat calls and regulator escalations, and flags decisions often reversed on appeal.
The moment
A member is turned down at a hospital reception. The member taps "Why?" and reads the reason in plain words: the doctor's code doesn't match their plan, and the hospital has been asked to resubmit.
Forty minutes later, the same message thread shows the request approved.
At the weekly review, angry callbacks about that reason are down by two-thirds, and complaints mentioning the regulator about it fell from 41 to 9.
A watch list of decisions overturned on appeal shows one reason reversed on 34% of appeals. It is now with the medical director as a coding fault.
What it does
- Approve an explanation and its doors
- Publish the decision card
- Door: request resubmission
- Door: open an appeal with a clock
- Door: referral to an alternative
- Send a suspected defect to the decision owner
What you see
A customer-facing decision card with three action doors (customer help widget or WhatsApp) plus an internal explainer studio, reversal watch and regulator shield
What it moves
Repeat contacts and complaints mentioning the regulator for each rejection reason, before and after it gets a plain explanation; how often people complete one of the three next steps; and how often each reason is reversed on appeal.
Built for
- Compliance, complaints & legal
- Contact-centre operations
