Tuesday, April 29, 2014

Medicare Appeals

Sometimes, Medicare beneficiaries feel they have been released from hospital, nursing home, home health agency or hospice care before they are ready to leave. All Medicare beneficiaries, whether covered under Original Medicare or a Medicare Advantage Plan, have appeal rights. This means that trained medical professionals will review the beneficiary’s medical record and decide whether the beneficiary has been released too soon or whether the timing of the release was correct.

Below are some steps to follow if you feel you are being released from a hospital, nursing home, home
health agency or hospice too soon:
  • Talk to your doctor about continuing your care.
  • Ask your case manager or social worker for an official (written) Medicare notice.
  • Follow the instructions on the notice. Masspro‘s helpline telephone number will be on the notice.
  • Masspro will ask you for your views and review your medical record.
  • You’ll be informed of Masspro’s decision first by phone and then by mail. At that time, you will also receive information about other appeal rights.
Call Masspro’s helpline at 1-800-252-5533, or Medicare at 1-800-MEDICARE (1-800-633-4227). You can call or you can ask a friend or family member to call for you.

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