When I was at BlueCross BlueShield of South Carolina, we grew the company’s Twitter account from zero to 10,000 followers without spending a dollar on ads. Most of it came from replying to people who had the flu.
(And, yes, I’m calling it “Twitter” here because the platform was still called Twitter when we first launched this social media strategy. And TBH, I’m still not 100% comfortable calling it “X”)
I spent 10 years at BlueCross before joining NP Strategy in January 2024. Plenty of what I learned there shapes how I advise clients now, and this story comes up in client meetings more than almost any other.
I posted a short version of this story on LinkedIn a couple of years ago, and it’s still one of the most-read things I’ve put there. I think it hit because it runs against how most brands treat social media. They publish, then wait. They answer the people who tag them. Everyone else in their market, talking openly about the exact problems the brand exists to solve, goes unheard.
This is the longer version, with the details that didn’t fit in a LinkedIn post and a few things I’d do differently today.
What we actually did
Every day, someone on my social media team searched Twitter for tweets posted in our market that used words like these:
- Sick
- Barf
- Flu
- Doctor
- Surgery
- ER
- Hospital
There were far more of them than we expected. Stomach bugs, a kid’s fever, a knee surgery scheduled for Friday, a long night in the ER. People post about this stuff constantly.
So we replied. Short notes, signed with the initials of whoever wrote them:
Wishing you a speedy recovery and hoping you feel your best soon. ^RC
Get well soon! Remember to take care of yourself and rest up. ^CL
Wishing you well as you recuperate. Let us know if there’s anything we can help with. ^LM
We never checked whether someone was a customer before replying. If they were, great. If they had coverage with a competitor, even better. Now they’d had a kind moment with a brand they didn’t do business with.
What happened
Not everyone was glad to hear from us. A few people told us, in so many words, to get lost. Others made it clear how they felt about insurance companies in general.
Most responses were warm, though, and they came with likes, retweets and follows. One reply showed up so often we started expecting it, some version of: Didn’t expect that. Nice to see an insurance company that actually cares.
That reaction is the whole point. Looking back, a few things were working in our favor.
- Nobody expected it. People brace for an insurance company to deny a claim. They don’t expect one to check in while they’re on the couch with a thermometer. The surprise is what got replies liked and shared.
- The timing was right. We weren’t interrupting anyone with an ad. We were responding to something they chose to post publicly, close to when they posted it.
- It happened in front of an audience. Every reply was visible to that person’s followers. One kind note to someone with 300 followers put the brand in front of 300 more people in a good light.
- It came from a person. Using our initials really mattered. A signed reply tells people someone actually read their tweet.
Most monitoring is set up to play defense
Almost every brand I’ve worked with since moving to the agency side has some kind of social monitoring in place. Usually it’s pointed at the company name, a few executive names and a list of crisis terms. The job is to catch complaints before they spread and flag anything legal should see.
That’s worth doing. It also turns monitoring into a smoke detector, something that only speaks up when there’s a problem.
The BlueCross program used the same kind of search for a different job. We weren’t looking for people talking about us. We were looking for people going through the exact thing our brand exists for, whether or not they’d ever think to tag us. That pool of conversations is much bigger than your mentions, and in our experience very few brands show up in it.
How to set this up for your brand
The platforms have changed since we ran this. Twitter is X now, and a lot of the conversation has moved to Threads, Reddit, TikTok comments, LinkedIn and Bluesky. The approach works on all of them.
- List moments, not brand terms. Write down what your customers are going through right before, during or after they need you. A moving company might search “closing on a house” or “signing the lease.” A regional bank might look for “first paycheck” or “car broke down.” Start with 15 to 25 terms.
- Keep it local if you are. If you serve a specific market, filter by location. A reply from a brand in your own state lands differently than one from a national account.
- Use the tool that fits your budget. Native search on X, Reddit and TikTok costs nothing. Listening platforms like Sprout Social, Brandwatch, Meltwater or Talkwalker save time once volume picks up.
- Put it on the calendar. We searched daily. Thirty focused minutes every morning beats a three-hour sweep on Fridays, because a reply only works close to when the post went up.
- Write guidelines, not scripts. Give the team sample replies and clear rules on tone, then let them write each one fresh. People spot copy-and-paste replies fast.
- Sign the replies. Initials or first names make the account feel staffed by humans.
- Track what comes back. Log replies sent, replies received, sentiment, profile visits and new followers. After a month you’ll know which keywords earn their spot on the list.
Guardrails I’d put in place today
Ten years inside a health insurer teaches you how fast a well-meaning reply can turn into a compliance question. Outbound commenting can go sideways quickly, especially in regulated industries. These are the rules I’d set before anyone sends a reply:
- No selling. The moment a get-well note turns into “have you thought about switching plans?”, you’ve spent the goodwill you were trying to build.
- Never ask for personal details in public. No questions about a diagnosis, a policy number or a claim. If someone wants help, move it to DMs or a phone line.
- Skip the serious stuff. A stomach bug is fair game. A cancer diagnosis, a death in the family or a mental health crisis is not the place for a brand to show up with a stock line.
- Bring compliance in early. Healthcare, finance and legal clients should have compliance review the keyword list and reply guidelines before launch, not after the first complaint.
- Let angry people have the last word. Some will tell you to go away. Don’t argue.
Watch how each keyword performs, too. If one keeps drawing hostile replies, drop it.
Start with one keyword
You don’t need a new platform or an ad budget to test this. Pick one moment your customers go through, search for it in your market tomorrow morning, and reply to five people the way a decent person would. See what comes back.
If a health insurance company can win people over by wishing strangers a speedy recovery, your brand probably has a way in too.
NP Strategy helps brands build social listening and community programs that go beyond tracking mentions. Get in touch if you want help setting one up.
