Monsoon is here: Why you're paying out of pocket for sudden illnesses despite having health insurance

Many people assume that having health insurance means they won't have to worry about medical expenses during the monsoon.

However, seasonal illnesses such as viral fever, dengue, malaria, and typhoid often lead to significant out-of-pocket spending long before a patient is admitted to a hospital.

“Health insurance and healthcare don't always begin at the same point. Health insurance is designed to protect families from significant medical expenses, particularly those arising from hospitalisation,” said Ryan Singh, Co-Founder & COO, Loop Health.

He added that a seasonal illness usually starts much earlier and unfolds over several days before a hospital admission, if one is required at all.

Why your health insurance may not cover all medical expenses?

A fever during the monsoon typically involves a doctor's visit, followed by blood tests to rule out infections such as dengue, malaria or typhoid, along with prescribed medicines.

“Even without hospitalisation, a family may easily spend ₹3,000 to ₹8,000 over a few days on consultations, diagnostic tests, medicines and travel, depending on the city and the course of treatment,” Singh mentioned.

According to him, these are the healthcare costs many people fail to anticipate because they arise before insurance coverage typically comes into effect.

He added, “If hospitalisation eventually becomes necessary, insurance may step in for eligible inpatient expenses, but a significant part of the spending has already happened before the claim is raised. This means that healthcare expenses don't necessarily begin when an insurance claim begins.”

Does this mean health insurance is not required?

The fact that health insurance doesn't cover every medical expense does not make it any less important.

“Insurance remains one of the strongest financial safeguards a family can have because it protects against large hospitalisation expenses. However, financial preparedness helps manage everything that happens before, between and after those events,” mentioned Singh.

Can preventive care help reduce healthcare costs?

“Health insurance and preventive healthcare work best together. One provides financial protection when serious illness occurs, while the other helps reduce the likelihood that an illness reaches that stage in the first place,” he mentioned.

He advises families not to delay doctor consultations, complete the prescribed course of medicines, and get recommended diagnostic tests done on time, as early treatment often leads to faster recovery and lower overall healthcare costs.

How to stay financially prepared this monsoon?

Singh advises families to take a few practical steps.

• Check what your health insurance policy covers and identify expenses that may have to be paid out of pocket.
• Keep a list of nearby network hospitals covered under your health insurance policy handy.
• Keeping a modest healthcare contingency fund set aside for seasonal medical expenses can help absorb routine consultations, medicines and diagnostic tests that may not always be reimbursed.