We Built an Entire System for Insurance Brokers — and Missed the Hospital Broker
- Khushi Berry
- Jan 9
- 4 min read
India spent decades solving the problem of insurance distribution. We created agents, brokers, aggregators, digital marketplaces, and advisory firms. We regulated them, licensed them, trained them, and built entire businesses around helping consumers choose the right policy. We did this because we acknowledged a simple truth: insurance is complex, confusing, and high-stakes. People need help navigating it.
What we never paused to ask was an equally important question. What happens after insurance is used?
Because the real financial exposure does not occur at the moment a policy is purchased. It occurs inside the hospital.
The irony is striking. We built an elaborate ecosystem to help people buy insurance — but left them alone when they actually need to use it. When families walk into hospitals for admissions worth ₹5–10 lakh or more, there is no professional sitting on their side of the table. No one is reviewing the estimates. No one is questioning inclusions. No one is negotiating packages. No one is optimising out-of-pocket costs.
We assumed insurance would take care of it. It doesn’t.
Insurance brokers exist because insurance is not a simple product. Hospitalisation is far more complex. Yet patients are expected to manage it themselves during moments of emotional distress, urgency, and fear. That gap is not accidental. It is structural.
Insurance brokers emerged because policy language was opaque, pricing varied widely, and consumers were vulnerable to poor decisions. Over time, the industry came to recognise that representation was necessary. We formalised it. We professionalised it. We regulated it. And we normalised the idea that nobody should buy insurance without advice.
But hospital pricing is just as opaque — if not more.
Hospital bills contain dozens of moving parts: packages, room categories, billing slabs, implants, consumables, non-payables, sub-limits, co-pays, and insurance exclusions. The final amount a patient pays is rarely predictable at the time of admission. Two patients undergoing the same procedure, at the same hospital, and with the same insurance ,can walk out with vastly different bills.
And yet, there is no widely accepted system of patient-side representation during hospital admissions.
This absence has consequences.
Hospitals negotiate aggressively with insurers, corporates, and government schemes. They sign contracts, agree on rates, and optimise margins. Dedicated pricing and revenue teams manage these negotiations on a daily basis. This is normal business behaviour. Hospitals are commercial organisations.
But patients enter the same system without leverage.
They receive “standard packages,” which are often just retail pricing. These packages are presented as fixed and urgent. Patients, overwhelmed by circumstances, rarely question them. By the time the final bill appears, negotiation feels both impractical and inappropriate.
The result is predictable. Patients overpay — not because care is expensive, but because pricing is unchallenged. This is where the missing role becomes obvious.
Insurance brokers assist consumers in selecting a suitable policy. Hospital brokers would help patients navigate hospital pricing and billing. One exists. The other doesn’t — at least, not traditionally. And that is the oversight.
We built insurance distribution systems assuming insurance would protect people financially during hospitalisation. In reality, insurance only covers what the policy allows. It does not negotiate what hospitals charge. It does not prevent inflated packages. It does not eliminate non-payables. It does not stop sub-limits from being triggered. It does not optimise room rent choices or implant pricing.
Insurance manages risk transfer. It does not manage cost control.
Cost control happens inside hospitals.
This is why patient-side hospital broking is not an optional layer — it is a necessary one.
Health Samadhan exists to fill this gap. We act as hospital brokers for patients, representing them before admission for planned and elective procedures. Our role is not medical. We do not influence treatment decisions or doctor choice. We focus exclusively on the financial structure of hospitalisation.
When a patient approaches us, we review their diagnosis, procedure recommendation, and existing hospital quote. We benchmark it. We negotiate across multiple hospitals. We work on package structures, inclusions, exclusions, non-payables, room categories, and insurance optimisation. We present clear options before admission so patients can make informed choices.
This is exactly what insurers do — but for institutions.
We do it for individuals.
The absence of hospital brokers has long been justified by culture. Healthcare is seen as sacred. Questioning costs is considered inappropriate. Patients are expected to trust the system entirely. But trust does not require silence. Hospitals themselves negotiate because they understand pricing is flexible. There is no ethical contradiction in patients doing the same.
The discomfort around hospital negotiations has only benefited one side.
And it is not the patient.
Introducing hospital broking does not threaten care quality. It does not commoditise healthcare. It simply introduces balance. When patients have representation, transparency improves. Pricing becomes clearer. Out-of-pocket costs reduce. And trust, paradoxically, increases — because expectations align with reality.
It is worth asking why we accepted insurance brokers so easily but hesitated to imagine hospital brokers. Perhaps because insurance buying happens in calm moments, while hospitalisation happens in crisis. Perhaps because the financial impact of hospital pricing was underestimated. Or perhaps because the system evolved without considering patient voices.
Whatever the reason, the gap is now impossible to ignore.
Healthcare spending in India is rising. Private hospitals dominate care delivery. Insurance penetration is growing — but so are out-of-pocket expenses. Families are financially exposed not because they lack coverage, but because pricing remains opaque.
The next evolution of Indian healthcare will not come from more apps, more cards, or more schemes. It will come from restoring balance at the negotiation table.
Patients deserve representation — not after discharge, but before admission.
That is the role hospital brokers were always meant to play.
And that is why Health Samadhan exists.
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