Ending Care Appeals:
If you are receiving care in a hospital or non-hospital setting and are told that your Medicare will no longer pay for your care, you have the right to a fast appeal if you feel that continued care is medically necessary. There are separate processes for hospital and non-hospital appeals. Non-hospital care includes care from a skilled nursing facility (SNF), Comprehensive Outpatient Rehabilitation Facility (CORF), hospice, or home health agency. You can appeal by following the instructions on the notices you receive.
If the QIO appeal is successful, your care will continue to be covered, including for the time you were appealing. If the QIO decides that your care should end, you can file a second appeal within the timeframe on your QIO denial notice.
There are five levels of appeal in total. The timing and agency involved depends on which type of care is ending and whether you have Original Medicare or a Medicare Advantage Plan.
Tips for filing Medicare appeals for care that is ending
- Follow instructions on the notices you receive.
- Stick to important deadlines.
- Keep original copies of information.
- Take thorough notes while appealing.
- Request a letter from your doctor or health care provider in support of your continued care to strengthen your appeal.
- For more guidance on appeals, contact your ASR Medicare Advisor, a broker, or local SHIP for more guidance on appeals.
- CONTACT AMERICAN SENIOR RESOURCES at 1-800-386-6160 TTY 711 M-F or SCHEDULE AN APPOINTMENT ONLINE WITH AN ASR LICENSED CONSULTANT.