Premiums Rising Fast, But Health Insurance Claims Still Test Patients’ Patience: LocalCircles Survey

Health insurance is supposed to act as a financial cushion when medical emergencies strike. But for many policyholders, the experience is turning out to be less reassuring than expected. A recent survey by citizen engagement platform LocalCircles suggests that while premiums have climbed sharply in recent years, several customers continue to face problems when they try to use their policies.

The survey received responses from more than 54,000 individuals spread across 323 districts. Participants included policyholders from cities as well as smaller towns. According to LocalCircles, the exercise was undertaken after the platform received a large number of complaints over the past year relating to rising premiums and difficulties during claim settlements.

The feedback gathered through the survey indicates that even though health insurance coverage has expanded, the experience of dealing with insurers during hospitalisation often remains complicated for many customers.

Premium Hikes Becoming A Major Concern

One of the clearest trends highlighted in the survey is the steep rise in premiums that many policyholders say they have seen over the past few years. Many respondents said that the cost of keeping their policies active has risen significantly.

More than 70 per cent of those surveyed said their premiums had increased by anywhere between 50 per cent and 200 per cent in the last three years. For several households, this has meant allocating a much larger portion of their annual budget to health insurance.

Insurance companies typically attribute premium increases to rising healthcare costs. Hospital treatment has become progressively more expensive, with healthcare costs continuing to rise year after year. As treatment costs rise, insurers often revise premiums to reflect the higher payouts they expect.

However, policyholders who took part in the survey said that the increase in premiums has not necessarily made the claims process easier. Many respondents said they were surprised to find that certain hospital expenses were either excluded from coverage or reimbursed only partially.

As a result, even insured patients sometimes end up paying a portion of the hospital bill from their own pockets.

Claim Settlement Issues Continue

The survey also sheds light on the difficulties many policyholders face while settling claims.

Around four in ten respondents who had filed claims said their claims were either rejected or only partly settled. Some policyholders said they were not given clear explanations when insurers reduced or declined their claims.

Respondents also pointed to delays in getting cashless claims cleared. In many cases, policyholders said they had to remain at the hospital for hours after treatment ended because the insurer’s approval for discharge was still pending.

When a family is already dealing with someone’s illness or hospitalisation, being made to wait like this only makes the situation more difficult.

Some respondents said insurers sought more paperwork or asked for further explanations while processing claims. This kind of repeated exchange can stretch the process and leave policyholders uncertain about how long the claim will take to be settled.

Need For Greater Clarity

The survey also indicates that the way insurers communicate with policyholders may need improvement. Many respondents said the terms of coverage, exclusions, and the claims procedure are not always explained clearly when the policy is sold.

People familiar with the sector say better coordination among insurers, hospitals, and third-party administrators could help speed up approvals for cashless treatment.

As healthcare costs continue to rise, more Indians are turning to health insurance for financial protection. For many policyholders, however, the survey suggests that while premiums have gone up sharply, the experience of making a claim has not improved to the same extent.