If you think you are being asked to leave the hospital too soon, please follow the information below.
Ask a hospital representative for a written notice of explanation immediately, if you have not already received one. This notice is called a "Notice of Non-Coverage." You must have this Notice of Non-Coverage if you wish to exercise your right to request a review by the PRO.
If the hospital and your doctor disagree, the hospital may request the PRO to review your case. If it does not make such a request, the hospital is required to send you a notice to that effect. In this situation, the PRO must agree with the hospital or the hospital cannot issue a Notice of Non-Coverage. You may request that the PRO reconsider your case after you receive a Notice of Non-Coverage, but because the PRO has already reviewed your case once, you may have to pay for at least one day of hospital care before the PRO completes this reconsideration. IF YOU DO NOT REQUEST A REVIEW, THE HOSPITAL MAY BILL YOU FOR ALL THE COSTS OF YOUR STAY, BEGINNING WITH THE THIRD DAY, AFTER YOU RECEIVE THE NOTICE OF NON-COVERAGE. THE HOSPITAL, HOWEVER, CANNOT CHARGE YOU FOR CARE UNLESS IT PROVIDES YOU WITH A NOTICE OF NON-COVERAGE.
If the notice of Non-Coverage states that your physician agrees with the hospital's decision:
If the Notice of Non-Coverage states that the PRO agrees with the hospital's decision:
NOTE: The process described above is called "immediate review." If you miss the deadline for this immediate review while you are in the hospital, you may still request a review of Medicare's decision to no longer pay for your care at any point during your hospital stay or after you have left the hospital. The Notice of Non-Coverage will tell you how to request this review.