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. You may also file an appeal if you wish to dispute a coverage or payment decision made by Medicare, your Medicare health plan or your Medicare Prescription Drug Plan. You have the right to appeal if you are denied:
- A request for 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 by reviewing 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 instructions 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 & 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 before the payment deadline for continued care
- Explain your options if you miss the deadline or decide to request a review later
- Help you file an appeal