Appealing Early Hospital Discharge How long should you stay in the hospital?
The answer is always the same. You should stay in the hospital as long as is medically necessary. In other words, how long you stay in the hospital should be based on your medical needs. To protect you from being discharged too soon, Medicare has established a free appeal process.
An Important Message from Medicare Whenever you stay in the hospital, you should receive a form called An Important Message from Medicare About Your Rights. The hospital must give you this form within two days of your being admitted to the hospital. The hospital must give you this form every time you are admitted. If you stay in the hospital longer than five days, the hospital will give you a second copy of this notice within two days of your discharge. This second notice is to remind you of your appeal rights. You will get this notice if you have Original Medicare or if you are a member of a Medicare Advantage plan such as an HMO. The form tells you what you can do if you are asked to leave the hospital before you are medically ready.
If someone tells you that you must leave the hospital before you feel well enough, you have the right to appeal by asking us for a free review of your case. Think of this review as your right to a second opinion about being medically ready to leave the hospital.
How Do I Appeal?
You will find our phone number and address in your copy of An Important Message from Medicare About Your Rights. Our address and phone number are Review Services Department, Quality Insights of Pennsylvania, 2601 Market Place Street, Suite 320, Harrisburg, PA 17110, 1-800-322-1914.
In order for us to review your case, you must:
- Call us immediately at 1-800-322-1914. A friend or family member can call for you.
- Tell the hospital you called Quality Insights.
After you call us, the hospital or Medicare Advantage Plan will give you another notice listing the reasons why they believe you no longer need hospital care.
You must call us as soon as the notice is issued. If you call during evening hours or on weekends or holidays, leave a message on our answering machine. We will call you back the next day. If you call Quality Insights before midnight of the day the hospital is supposed to release you, you can't be forced to leave the hospital. You can stay in the hospital while we review your case. You will not be charged for the review or for the days you stay in the hospital while we review your case.
The Review
When you call Quality Insights, we will ask you for the following information:
- your name
- your phone number
- your Medicare number
- the name of the hospital you are in
- the date the notice was issued
- some questions about your situation
We will then call the hospital for a copy of your medical record. The hospital must send us your record within 24 hours. Once we receive your record, one of our physicians will review your case to decide whether you need to stay in the hospital. The physician’s decision is based on Medicare guidelines. If our doctor decides you need more hospital care, you can stay in the hospital. If we decide you can stay in the hospital, Medicare will pay for your hospital stay.
Medical Necessity If you do not need hospital care, Medicare will no longer pay for your hospital stay after we make the decision. Keep in mind that medical necessity is based on whether the care you need can be provided only in a hospital, not on your desire to stay in the hospital.
If you want to stay in the hospital after we say that Medicare will no longer pay, you will have to pay for the rest of your stay. However, you will not have to pay for the time we were doing the review, no matter what our decision. Even if we decide you no longer need hospital care, you don’t have to pay for the time we spent reviewing your care.
