Council on Aging Answers 2015 - 101

COUNCIL ON AGING - ORANGE COUNTY

Medicare. It must give you this notice as far in advance
of your discharge as possible, but no more than 2 days
before your planned date of discharge. The second
notice is not required during very short hospital stays if
the original notice was given to you within two days of
your planned discharge date.
If the hospital gives you the second notice on the
date of your discharge, it must deliver it to you at least
four hours before your planned discharge.
The hospital must deliver the Important Message
from Medicare to you in person. However, if you
cannot understand the notice, the hospital must
deliver it to your representative and ask him or her to
sign it. Your representative can be someone who has
legal authority to act for you, a family member or close
friend.

Council On Aging-Orange County | 714-479-0107 | www.coaoc.org

Additional Resources
Contact your local Health Insurance Counseling
and Advocacy Program (HICAP) office for help
with Medicare concerns. Call 1-800-434-0222
to be connected automatically with the HICAP
office in your California County or go to www.
cahealthadvocates.org for information about Medicare
and HICAP in California. HICAP is a no-cost service
to help you understand and maximize your Medicare
benefits. Funded in part by the California Department
of Aging, HICAP is the most dependable source of
unbiased, accurate, and up-to-date Medicare-related
information.
You can also contact Medicare directly at 1-800-
MEDICARE (1-800-633-4227) or find resources on
its web site at www.medicare.gov.
Excerpts from California Advocates for Nursing
Reform (CANHR) www.canhr.org
Answers Guide 2015

101

INSURANCE

Appealing Hospital Discharge Decisions
Your hospital, doctor, or Medicare health plan will
inform you of your planned date of discharge. If you
think you are not ready to leave the hospital, tell your
doctor and the hospital staff immediately about your
concerns. You have a right to appeal the decision. Ask
your doctor or discharge planner to see if the hospital
will extend your stay. Ask for a Hospital-Issued Notice
of Non-coverage (HINN), if one has not been issued.
You should request an appeal if your concerns
about early discharge are not resolved. You have the
right to immediate review by the Beneficiary and
Family Centered Quality Care Quality Improvement
Organization (BFCC-QIO) who handles appeals. You
can stay in the hospital and Medicare will continue
to cover your stay as long as you file the appeal before
you are discharged. Once you appeal, you will not have
to pay for the services you receive during the appeal
(except for charges like co-pays and deductibles). It is
best to file your appeal on or just before the planned
date of discharge. Ask for an "Immediate Review."
Your representative, such as a legal agent or family
member, can file an appeal on your behalf.
To file your appeal, call Livanta, the West Coast's
Beneficiary and Family Centered Care - Quality
Improvement Organization (BFCC-QIO) at 1-877-5881123 or visit www.BFCCQIOAREA5.com. Tell them
why you object to the planned discharge and provide
any information that supports your appeal.
What will happen during the BFCC-QIO's review?

When the BFCC-QIO gets your request within
the fast appeal time frame, it will notify the hospital.
Then, the hospital will give you a "Detailed Notice of
Discharge" by noon of the day after the BFCC-QIO
notifies the hospital. This notice will articulate the
reasons the hospital feels the discharge is appropriate.
The BFCC-QIO will look at your medical information
provided by the hospital and will also ask for your
opinion. The BFCC-QIO will decide if you're ready to
be discharged within one day of getting the requested
information.
If the BFCC-QIO decides that you're being
discharged too soon: Medicare will continue to cover
your hospital stay as long as medically necessary
(except for applicable coinsurance or deductibles).
If the BFCC-QIO decides that you're ready to be
discharged and you met the deadline for requesting
a fast appeal: You won't be responsible for paying the
hospital charges (except for applicable coinsurance or
deductibles) incurred through noon of the day after the
BFCC-QIO gives you its decision.

http://www.cahealthadvocates.org http://www.cahealthadvocates.org http://www.medicare.gov http://www.BFCCQIOAREA5.com http://www.canhr.org http://www.coaoc.org

Council on Aging Answers 2015

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