A recent study mapping patient and patient-family experiences in claiming their health insurance has pointed to “transparency” as a key ask from customers who, for example, would like to have granular details on why their insurance claim was rejected, rather than merely being told their claim was rejected, says Policybazaar (PB).

Customers seek greater clarity and proactive communication, among other things, the second edition of PB’s claims study revealed. In fact, a ‘Health Claims Experience Index’ launched by the study pegs the overall claims journey score at 82.8 on 100, indicating the “claim process (was) functional, but not frictionless,” the report said. The Index, said to be an industry first, will be launched this week.

“While claim settlement ratios remain the industry’s most widely tracked metric, there has been no standard framework to evaluate the actual customer experience during claims. The HCX Index seeks to bridge this gap by measuring both operational efficiency and customer sentiment across the claims journey,” explained the report titled “Is India happy with health insurance claims? 2.0”.

Cashless health insurance fared better with an Index score of 86.7, driven by process improvements that are real and measurable, noted Sarbvir Singh, Joint Group Chief Executive, Policybazaar. “But those who were pushed toward reimbursement by denial, network gaps or discharge pressure, face a relatively harder journey,” he said, giving an overview on the study. “A denied claim without an explanation does not just frustrate a customer; it breaks trust in a way that is very hard to rebuild,” he added.

The study surveyed 2,228 Indians across metros and Tier-2 and Tier-3 cities who had been hospitalised themselves or a loved one, and had filed a health insurance claim between August 2024 and September 2025, PB said. This included non-customers across all channels who filed health insurance claims, PB added. About 70 percent of those surveyed opted for a cashless service, where the insurance company directly paid the hospital, following hospitalisation.  

Lower reimbursement score

Many claimants opted for reimbursement when cashless was unavailable, delayed or not worth waiting for at discharge, the study said. “This becomes more stressful when customers must arrange funds upfront,” it said, adding that 76 percent of reimbursement claimants reported borrowing funds during treatment, up from 68 percent last year. “Lack of upfront cashless support can quickly create financial pressure, even if claims are later reimbursed,” it said.

Reimbursements’ lower Index score at 73.7 reflected the “effort-heavy journey”, besides the “responsibility customers carry across payments, documentation, follow-ups and settlement.”

The report’s findings “reveal a paradox”, it said. “Cashless approvals are getting faster and smoother. Yet for too many policyholders, the emotional and administrative burden remains as heavy. To bridge this gap, the industry must move from “reactive processing” to “proactive protection”, it said.

Good-faith discharge

The study suggested measures including greater visibility on consumables and “hidden deductions” and a shift from a “patient collateral to a good-faith discharge” approach, where the patient’s physical hospital discharge was decoupled from final administrative closure. Other suggestions included greater verification at policy purchase, real-time claim tracking, deeper hospital-insurer integration and reduced paperwork to make health insurance claims faster, simpler and more dependable, PB said.

“Health insurance ultimately proves its value at the time of a claim. While claim settlement ratios provide an important view of insurer performance, they do not fully capture what customers experience during the claims journey,” said Singh, adding that the Index aimed to bring in transparency and customer-centricity into health insurance by creating a common benchmark for measuring claims experience.

“As the industry evolves, the next frontier is not just settling claims, but ensuring customers clearly understand claim decisions and have confidence in the process,” he said, in a note on the study.

Published on June 22, 2026