Health insurance claims need transparency to restore patient trust

Raj Kiron Das: Health insurance stands as one of the most relied-upon safeguards in modern healthcare, yet the experience of navigating a claim often feels deeply separating to the very people it is meant to protect. When illness attacks, patients expect clarity, support and economic assurance. Instead, many come upon a system defined by unfamiliar terminology, vague decisions and a communication gap that leaves them confused at best and overwhelmed at worst. These disconnect demand urgent reform grounded in transparency, empathy and collective responsibility.

Behind every submitted claim lies a process few patients ever see. Hospitals forward documentation to insurance companies, where internal teams and automated systems evaluate policy rules, treatment justification and network agreement. Although this step may exist to ensure accuracy, their obscurity reinforces a perception that decisions are made without regard for the human beings they affect. Patients often have no insight into why certain charges are approved while others are denied, or how contractual discounts shape the final cost of care. As a result, the claims journey feels unpredictable and emotionally fraught, especially for older adults and families already burdened by illness.

The Explanation of Benefits, intended to clarify this process, frequently deepens the confusion. Dense language, unfamiliar code and technical classification make the document intimidating rather than informative. Many patients misinterpret it as a bill, misunderstand their financial responsibility or assume they have no recourse when a claim is denied. This inability to make out necessary information erodes trust not only in insurers but in the healthcare system as a whole.

At the root of this challenge is a collective failure to communicate clearly. Insurers routinely advise individuals to aspire to care in preferred networks to control cost, yet the real-world implications of these networks are seldom explained in a way ordinary people may understand. Hospitals often leave patients to navigate insurance responses on their own, while policymakers have yet to enforce strong standards for accessible communication. The result is a system where the burden of understanding falls almost entirely on those least equipped to shoulder it.

There are, however, encouraging signs of what a more humane approach could look like. Organisations dedicated to patient advocacy, like Align Senior Care, demonstrate how guided explanation, billing reviews and personalised support may transform the claims experience. By turning complex administrative steps into understandable conversation, they help restore a sense of control for patients who otherwise feel lost in paperwork.

Still, systemic change must go much further. The health insurance claims process touches people at some of the most vulnerable moments of their lives. A compassionate healthcare system cannot treat clarity as an optional courtesy. It must place patients at the centre of communication, redesign documents for real comprehension and ensure that all institutions involved take responsibility for the confusion it makes.

Health insurance should provide reassurance, not uncertainty. When the claims process becomes clear, humane and answerable, it strengthens public trust and allows patients to focus on healing rather than making out paperwork. Only then may the promise of health coverage truly be fulfilled.