I received a discharge notice from the hospital, but I need to continue medical care. I think I can appeal but I’m not sure what to do. Please help!
-Lorraine (Buffalo, NY)
You’re right! If you think you’re being discharged from the hospital too soon, you do have the right to file an appeal.
You should’ve gotten a notice that explains this right titled, Important Message from Medicare, when you were admitted. If you were there more than 3 days, you should receive another copy of the same notice between 4 hours and 2 days before you are to be discharged.
The Important Message from Medicare notice will have instructions for filing a fast (expedited) appeal. This appeal will be sent to the Quality Improvement Organization (QIO), a company that is contracted to evaluate discharge appeals. For a fast appeal, you must appeal by no later than midnight on the day of your scheduled discharge. Once you file the appeal, the hospital must give you a Detailed Notice of Discharge, which must explain, in specific detail, why the hospital believes that Medicare coverage for your stay is ending, and that discharge is appropriate. You can also send additional information about why you, and your care team, if appliable, believe the discharge is too soon. The QIO should call you within 24 hours with their decision.
If the QIO agrees with the hospital that Medicare coverage of your hospital stay should end, you have the right to continue to appeal to higher levels of review. If you stay in the hospital after the QIO decision agreeing with the hospital, however, you may be responsible for the full cost of your care from the date of that decision forward if you don’t win at a higher level of appeal. There are five levels of appeal and instructions for the next steps are included in each decision. Keep in mind that at each level there is a separate time limit for when you must file the appeal and when you’ll receive a decision.
Here are a few tips to help you succeed:
- Follow the appeal timelines for each level.
- Take good notes throughout the process & keep original copies of all documents.
- Include a letter from your doctor or other care-team member explaining why your specific circumstances require additional hospital care to support your appeal.
- Contact your State Health Insurance Assistance Program (SHIP) for more guidance on your appeal.
(Later appeals processes differ for Medicare Advantage and Original Medicare. For more information about higher levels of appeal if you are in a Medicare Advantage plan, see: Medicare Advantage appeals if your care is ending – Medicare Interactive. For more information about higher levels of appeal if you have Original Medicare, see Original Medicare appeals if your care is ending – Medicare Interactive)