Background <p>The provision of quality healthcare is a global priority, particularly for countries like Syria, which has recently emerged from a devastating war. Many countries, including Syria, have implemented health insurance systems that aimed to reduce government health expenditure and improve access to healthcare services. This study aims to investigate the quality of health insurance services in Syria from the perspective of customers and to identify areas for improvement.</p> Methods <p>We conducted a cross-sectional study utilizing the SERVQUAL metric, evaluates service quality across five dimensions: attitude, safety, efficiency, reliability and trustworthiness, and responsiveness. Data were collected through an online questionnaire targeting Syrian residents who have utilized health insurance services.</p> Results <p>A total of 284 participants were enrolled in the study, comprising 134 females and 150 males. The findings indicated that the quality of health insurance services in Syria is perceived as average or below average across all SERVQUAL dimensions. Notably, respondents expressed significant concerns regarding the attitude of medical staff, rating it well below average, while safety, reliability and trustworthiness were perceived as average.</p> Conclusion <p>Insured patients felt mistreated by healthcare providers compared to those who pay-out-of pocket. This perception is exacerbated by the limited coverage and long waiting times for approval. It is recommended that the Insurance Supervisory Commission, as the regulator of insurance sector, closely monitor the quality of services provided by health insurance companies to ensure that these services are respectful, responsive and readily available. Furthermore, health insurance companies should leverage digital technologies and artificial intelligence to enhance customers experience and improve service quality.</p>