Excluded Hospitals List by HDFC ERGO List

Specifics of one’s health insurance can end up playing a very important role in how to manage health needs and finances. HDFC ERGO Health Insurance is a leading provider in India and offers a wide range of health insurance policies that are custom-made to the wishes and requirements of any type of policyholder. One Critical aspect of these plans is the hospital exclusion list because it can have a big effect on your limit that could get coverage.

This article is going to discuss what the HDFC ERGO exclusion list of hospitals means for your coverage and provides insights that are needed to wisely make your way through the health insurance benefits.

What is an exclusion list? 

An exclusion list in health insurance refers to those specific services, treatments, or a type of health care provider who will not be included for coverage under a particular health insurance policy. It is of immense importance to know these exclusions, as they define the boundaries of your insurance policy.

Hospital exclusion list for certain hospitals and medical facilities where treatment is not payable under the Health Insurance Plans to HDFC ERGO’s policyholders.

In most cases, exclusion lists are put in place for control over cost and management of the insurance provider’s liabilities. High-cost hospitals or even hospitals with poor metrics that are excluded mean that the insurer can offer more affordable premiums to its customers.

This, however, would mean that a policyholder may have to pay out of pocket if he seeks treatment at such excluded hospitals.

Understanding Excluded Hospitals List by HDFC ERGO 

The hospital exclusion list of HDFC Ergo is included in the policy documentation of the insurer and updated at regular intervals to reflect the changes taking place in their network of covered hospitals.

This list generally includes high and above market rate hospitals or those which, in the past, have been found indulging in fraudulent practices. Sometimes, even the hospitals themselves are excluded because they do not own some of the standards or certifications required.

Reasons for Hospital Exclusions :

Quality of Care: Hospitals may be excluded from quality-based norms or if the hospitals have poor results based on patient outcomes.

Cost Controls: Some hospitals can become too costly for what the insurer might be willing to cater to and thus find them out of the network.

Fraudulent Practices: Facilities doing fraudulent practices, or in general, conducting unethical billing, are usually excluded to save the policyholders’ and the insurance company’s interest.

Specialized Services: It may be that there is an exclusion regarding the specialized nature of treatment provided by the hospital, of which the coverage is not afforded in usual health insurance plans.

Impact on Policyholders

Out-of-Pocket Expenses: If beneficiaries receive services from a hospital on this list of exclusions, they may be responsible for the entire bill out of their pocket.

Limiting choices: Most probably, the list is going to limit your options for nearby or preferred healthcare facilities.

Need for Awareness: Policyholders need to know the kind of excluded hospitals. This will prevent them from being caught unaware of what they are charged and plan for their treatment accordingly. ”

How to handle Exclusions:

Check the policy detail: Always, one needs to go through the terms and conditions of the health insurance policy to understand which hospitals are excluded.

Pre-Approval: Pre-approval from the insurance company for planned hospitalizations may help clear whether coverage is provided for a particular hospital or not.

Consult Customer Service: Where in doubt, please consult the latest information about Excluded Hospitals or indeed any other detail of cover from the customer service of the insurer.

The policyholder has to keep himself updated and informed at the time of making critical decisions regarding the place where care should be delivered.  The policyholders should, therefore, go through this list before seeking any medical treatment. Knowing which hospitals are out of exclusion will be great for making plans for your treatment in institutions that accept your health insurance and hence avoid unexpected medical bills. For the details of which hospitals are a part of the exclusion list, please refer to the below policy document of HDFC ERGO :