If you asked a Quality Improvement Organization (QIO) to review the hospital's decision to discharge you, and the QIO decided against you, you can appeal.

If you are still in the hospital

If the QIO decides against you and you are still in the hospital, you can ask it to reconsider its decision within 60 days after you receive notice that your first request has been turned down. The QIO must issue a reconsideration decision withing 14 days of receiving the request for reconsideration.

If the QIO upholds its decision after reconsideration, you can appeal to the higher levels: an Administrative Law Judge (ALJ), then the Medicare Appeals Council (MAC), and then the Federal District Court.

If you are no longer in the hospital

If the QIO decides against you and you are no longer in the hospital, you can appeal to the ALJ no later than 60 days after you receive the QIO notice, if at least $140 is at stake.

If the ALJ upholds its decision, you can appeal to the MAC and then to Federal District Court.

To find out the timeframes for upper levels of appeal, click on "Timeline for filing Medicare private health plan appeals" in the GO TO box.