Dear Marci,

My wife is currently a hospital inpatient following a surgery. She is getting excellent care, but we are both nervous about what would happen if she were discharged before she is ready. What should we do if that happens?

George (Hartford, CT)

Dear George,

First, know that your wife has a right to discharge planning as a hospital inpatient, which will give her a chance to address any concerns she has about her health and safety after she leaves the hospital. If she is discharged before she is ready, though, she also has the right to a fast appeal to challenge her provider’s decision to end her care. This is called an expedited appeal. To have the highest chance of being successful, you should pay attention to the paperwork your wife receives, and follow directions and deadlines as closely as possible. Also, know that if your wife is too ill or unable to file an appeal for herself, you, another family member, or representative can do so for her.

Your wife should have received an Important Notice from Medicare within two days of being admitted to the hospital as an inpatient. This notice has information on how to appeal her discharge. She should receive this notice again no less than four hours before her discharge. In order to begin your wife’s appeal, follow the instructions on this message to file an expedited appeal to the Beneficiary and Family-Centered Quality Improvement Organization (BFCC-QIO, or QIO for short). She must appeal to the QIO by midnight on the day of her discharge. If she misses this deadline, she will be able to appeal according to the Original Medicare standard appeal process or the Medicare Advantage post-service standard appeal process. She may also be able to request a good cause extension if exceptional circumstances kept her from filing her appeal on time. These extensions are granted on a case-by-case basis.

Once your wife appeals to the QIO, the hospital must give her a Detailed Notice of Discharge. This notice explains in writing why hospital care is ending and lists any Medicare rules related to your wife’s case. At this time, the QIO will also request your wife’s medical records from the hospital. You may also ask the hospital for a copy of these records, although the hospital may charge you to access them. The QIO will also likely call your wife at this time to get her opinion on the discharge, but she may also submit a written statement.

Within 24 hours of receiving all the information it needs, the QIO should call your wife with its decision. If this decision is favorable, her care will continue to be covered.

If the decision is unfavorable, your wife will not be responsible for the cost of the 24-hour period she spent in the hospital waiting for the QIO to make its decision. If she remains in the hospital past this period, however, she will be responsible for the cost of her care if she does not win at a higher level of appeal.

If you and your wife are unsuccessful at appealing her discharge at this first level, you can continue to appeal. The steps in the processes are different depending on whether your wife is covered by Original  Medicare or a Medicare Advantage Plan.

Throughout the appeals process, it is important to try to get support from your physician to support the medical necessity of your hospital stay. Follow all instructions and deadlines very carefully, and keep copies of all appeal paperwork.

-Marci