Dear Marci,
I have been an inpatient at a hospital for a week, and I just received a notice that Medicare will no longer pay for my stay. I will be discharged from the hospital in two days, but I don’t think I have recovered enough to leave yet. How can I appeal my discharge from a hospital?
- Ruby (South Bend, IN)
Dear Ruby,
If you are receiving care in a hospital and are told that your Medicare will no longer pay for your care (and you will be discharged), you have the right to file a fast appeal if you do not believe your care should end.
If you are a hospital inpatient, you should receive a notice titled Important Message from Medicare within two days of being admitted. This notice explains your patient rights, and you will be asked to sign it. If your inpatient hospital stay lasts three days or longer, you should receive another copy of the same notice up to two days, and no later than four hours, before you are discharged.
If you think you are being discharged too soon, follow instructions on the Important Message from Medicare to file an expedited appeal to the Quality Improvement Organization (QIO). Contact the QIO by midnight of the day of your discharge.
Once you file the appeal, the hospital must give you a Detailed Notice of Discharge, which explains in writing why your hospital care is ending. The QIO should call you with its decision within 24 hours of receiving all the information it needs.
If the QIO decides your care should end, you will be responsible for paying for any care you receive after noon of the day after the QIO makes its decision. If your appeal to the QIO is successful, your care will continue to be covered.
If your appeal is denied at this first level, you can continue to appeal by following instructions on the denial notices you receive. There are five levels of appeal in total; the timing and agency involved depend on whether you have Original Medicare or a Medicare Advantage Plan. You have the right to continue appealing if you are not successful. If you are unable to appeal, a family member or other representative can appeal for you.
Expedited appeals have tight deadlines, so it is important to pay attention to the timeframes for appealing at each level. Keep copies of any appeal paperwork you send out, and if you speak to someone on the phone, get their name and write down the date and time that you spoke to them. It is helpful to have all of your appeal documents together in case you run into any problems and need to access documents you already mailed.
- Marci
