An Important Message From Medicare -- "Your Rights While You Are A Medicare Hospital Patient" Form

That form must be given to you when you are admitted. Here's a summary of what it says for most hospitals.
If your doctor or hospital tells you that you are going to be discharged, and you think it is too soon, you have 3 options:
 

Option #1 Immediately ask a representative of the hospital for a written explanation, if you have not already received one. It is called a "Notice of Noncoverage." This notice will tell you if your doctor or your hospital's Peer Review Organization (PRO) agrees with your hospital's decision to discharge you.

  • You should be given the Notice at least 3 calendar days before your discharge date. Even if you decide not to appeal your hospital's decision, your hospital cannot charge you (you pay nothing) for the cost of your stay during those 3 days. If your hospital has not given you the Notice, the 3-day clock does not begin until they do.

 

  • Tip: This is especially important if the hospital wants to send you to a rehab facility to continue your recovery (most rehab facilities are skilled nursing facilities / nursing homes, not assisted living facilities). You don't have to go the facility where the hospital wants to send you; instead, use these 3 days to find the best one that's certified by Medicare.
  • If you don't, and you later move into another rehab facility, Medicare won't cover you there, even if the second one gives you a better chance for full recovery. Instead, you'll have to pay the entire cost of your stay in the second facility out of your own pocket.

 

Option #2 If you decide to appeal and your doctor agrees with your hospital. You must ask the hospital's PRO to review the discharge decision. You can contact the PRO in writing or by phone. (The Notice includes the PRO's address and telephone number.) But, you must make your request before noon of the first work day after you receive the Notice.

  • If the PRO agrees with the Notice, you may be billed for the costs of your hospital care incurred beginning from noon of the day after you receive the PRO's decision. You will not be charged for your hospital care from the time you make your request until you receive the PRO's decision that it agrees with the hospital. Of course, if the PRO disagrees with your hospital, Medicare will continue to pay for your hospital care.

 

Option #3 If your doctor disagrees with your hospital. Your hospital may ask the PRO to review your case. If the PRO agrees with your hospital, and you still feel that you are being discharged too soon, your can ask the PRO to reconsider their decision. Your request must be made by phone or in writing to the PRO immediately as soon as you receive the Notice.

  • The PRO can take up to 3 working days to complete their review. It will inform you in writing of its decision. But, remember that in this example, the PRO has already reviewed your case once (before the Notice was issued).

 

  • As a result, your hospital is allowed to begin billing you for your care beginning with the 3rd calendar day after you receive the Notice, even if the PRO has not completed its review. If the PRO continues to agree with your hospital, you may have to pay for at least one day of hospital care.


Now that you know your rights, it's important to stand up for them. Many people, especially seniors, are afraid they might anger hospital staffers or their doctors, so they don't ask questions or complain, even when they aren't being treated right. Remember, you have the right to be fully informed, to be involved in the decision-making process regarding your health care, and to receive all the hospital care necessary for the proper treatment of your illness or injury.

 

 

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