Your appeal rights if you were asked to leave the hospital and you missed the deadline for asking for an immediate review of your case (Medicare Advantage)

Question 7 of 8 (use "Last" or "Next" buttons to see more)
Last Update: November 02, 2011

If you missed the deadline for asking for an immediate (expedited) review of your case by the Quality Improvement Organization (QIO), you can still appeal.

However, if you want to appeal after the deadline for asking for immediate review by a QIO has passed, the hospital can charge you for care you received after the date the hospital planned to discharge you. If you win the appeal, the hospital must reimburse you if you already paid.

  • You can request a fast review (expedited reconsideration) from your Medicare private health plan (an expedited appeal for care). You must file this request within 60 days of the date the hospital wanted to discharge you. If your plan turns down your request, you can appeal further.
    • For more information on how to make an expedited appeal for care, click on "What can I do if my Medicare private health plan refuses to let me get care I need immediately?" in the GO TO box.

  • If you stayed in the hospital past the date the hospital originally wanted to discharge you, but have since left, you can appeal for payment of the care you already received (a standard appeal for payment). If your plan turns down your request, you can appeal further.
    • To find out how to appeal to your plan to pay for care you already received, click on the link in the GO TO box.

       


Related Questions
Can my state give me more rights and protections than federal law regarding Medigap plan enrollment?

Donate Now!
State:  
If you would like to find information specific to your state, press the arrow on the drop down menu to select your state.
 
 
Go to previous question Go to next question
 
GO TO
What to do if your Medicare Advantage plan refuses to let you get care you need immediately

What to do if your Medicare Advantage plan refuses to pay for care you already received

Your appeal rights if you were asked to leave the hospital and you missed the deadline for asking for an immediate review of your case (Original Medicare)

Your appeal rights if you feel you are being asked to leave the hospital too soon

 
LINKS
American Hospital Association: Quality and Patient Safety

Medicare Publication - Your Rights and Protections (PDF)

MyMedicare.gov: Access your Medicare information

Directory of Quality Improvement Organizations by State

The National Committee for Quality Assurance (NCQA)

State Health Insurance Assistance Program (SHIP) Directory

 
< Last | Next >