Cautious / Excluded Hospital List

Cautious Hospitals / Excluded Hospitals lists are used to guide policyholders in selecting healthcare providers and to manage costs and risks associated with medical treatments.

1. Cautious Hospital List :

  • This list typically includes hospitals that may have a history of higher costs, lower quality of care, or other factors that raise concerns for the insurance company.
  • Policyholders are advised to approach these hospitals with caution and may face restrictions or higher out-of-pocket costs when seeking treatment at these facilities.

2. Excluded Hospital List :

  • Hospitals on this list are excluded from the insurance company's network altogether.
  • Policyholders usually may not receive coverage for medical services obtained at these hospitals, except under specific circumstances.

These lists are dynamic and subject to change based on factors such as hospital performance, fraudulent claims, negotiated agreements, and shifts in healthcare trends. It's essential for policyholders to review these lists periodically.