Star Health CEO Anand Roy has urged hospitals to implement ICMR treatment guidelines for all patients to standardize billing and reduce claim disputes. This shift aims to control escalating medical inflation, a critical factor impacting insurance margins. The company recently posted a 25% rise in Q1 FY27 net profit, supported by improved underwriting efficiency and AI-led claims processing.
Anand Roy, the Managing Director and CEO of Star Health and Allied Insurance, has called for a universal approach to hospital billing and treatment. He is urging healthcare providers to follow the Indian Council of Medical Research (ICMR) protocols for all patients, not just those covered under government schemes like the Pradhan Mantri Jan Arogya Yojana (PM-JAY). This move is aimed at curbing unnecessary hospitalizations, reducing billing disputes, and managing the rising cost of medical care.
Industry Pressure and Standardization
The call for standardization comes as insurance companies and hospitals continue to navigate friction over billing practices. The General Insurance Council (GIC) has recently highlighted that evidence-based treatment guidelines are essential for managing healthcare expenses without interfering with the clinical independence of doctors. Disputes over hospitalization necessity and the final invoice amount remain primary drivers of customer grievances. By standardizing treatment paths, insurers hope to bring more transparency to hospital bills and reduce the gap between what is charged and what is covered by insurance.
Tech-Driven Efficiency and Financials
Beyond protocol standardization, Star Health is focusing heavily on technology to improve its operational efficiency. The company is actively integrating the National Health Claims Exchange (NHCX), a platform designed to act as a single digital gateway for claims, similar to how UPI simplified banking payments. Furthermore, the insurer is using Artificial Intelligence to speed up claim settlements, with 81% of cashless claims now processed within one hour.
These operational improvements have reflected in the company’s recent financial results. For the first quarter of the 2027 fiscal year, Star Health reported a net profit of ₹550 crore, a 25% increase compared to the same period last year. The company’s underwriting profit saw a sharp rise to ₹111 crore, while its combined ratio—a measure of profitability where a lower number indicates a more profitable operation—improved to 97%. This financial progress is also supported by the company’s expansion into tier-2 and tier-3 cities with affordable insurance products.
Risks and Future Monitorables
While the company is showing growth, it continues to face challenges. Medical inflation remains a significant risk, as rising hospital costs can quickly erode profit margins if premiums are not adjusted accordingly. The ongoing tension between hospitals and insurers regarding billing transparency could also impact the speed of claims settlement if not managed well. Investors may track whether the push for standardized protocols effectively reduces loss ratios over the coming quarters and how the company balances its aggressive expansion in smaller cities with the need to maintain underwriting discipline.