If you have Medicare, you can file an appeal if you do not agree with a health care provider’s decision to discharge you from the hospital or discontinue services, or if you wish to dispute a coverage or payment decision made by Medicare, your Medicare health plan or your Medicare Prescription Drug Plan.
If you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan, you can file a formal appeal through Medicare. You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of these:
- A request for a health care service, supply, item, or prescription drug that you think you should be able to get
- A request for payment of a health care service, supply, item, or prescription drug you already received
- A request to change the amount you must pay for a health care service, supply, item, or prescription drug
You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need.
Start with taking a look at your Medicare Summary Notice (MSN). If an item or service is denied, call your doctor's or other health care provider's office to make sure they submitted the correct information. If not, the office may resubmit. If you disagree with any decision made, you can file an appeal. The last page of the MSN gives you step-by-step directions on when and how to file an appeal.
If you think your Medicare services are ending too soon (e.g. if you think you are being discharged from the hospital too soon), you can file an appeal with your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). The BFCC-QIO for your state will:
- Give you the information you need to make an informed decision
- Explain your options
- Help you file an appeal
Your state's BFCC QIO can also refer family members or caregivers to the Beneficiary Care Management Program during the review of a discharge appeal, in order to provide assistance with discharge instructions, post treatment plans, follow up care with primary care physician, and to assist with referring patients and families to local resources.
Your state’s BFCC-QIO will provide the necessary information to help you make a decision before the payment deadline for continued care.
The BFCC-QIO can also explain your options if you miss the deadline or decide to request a review later.
To contact your BFCC-QIO for help with filing an appeal, find your BFCC-QIO in the contact list below.
BFCC-QIO Contact Information by Region or State
Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont
New Jersey, New York, Puerto Rico, Virgin Islands
Delaware, DC, Maryland, Pennsylvania, Virginia, West Virginia
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Iowa, Kansas, Missouri, Nebraska
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Arizona, California, Hawaii, Nevada, Guam, N. Mariana Islands, American Samoa
Alaska, Idaho, Oregon, Washington