Member Appeal Rights for Hospital Discharge

Members who are hospitalized at an inpatient facility have special appeal rights if they are dissatisfied with the discharge plan or believe that coverage of their hospital stay is ending too soon.  

Hospitals are required to notify all Medicare Advantage members who are admitted to the hospital of their hospital discharge appeal rights. Hospitals must issue the standard CMS form An Important Message from Medicare About Your Rights twice— the first time within two calendar days of admission and the second time no more than two days and no less than four hours before discharge. Each time, the hospital must obtain the signature of the member or of their representative and provide a copy.  

Note: A link to the form An Important Message from Medicare About Your Rights is found at: cms.gov > Covering more Americans > Medicare > Medicare Program – General Information > Beneficiary Notices Initiative > Hospital Discharge Appeal Notices > Important Message from Medicare - English and Spanish.  

Medicare Advantage members have the right to appeal to the Quality Improvement Organization (QIO) for immediate review when a hospital and Blue Cross and Blue Shield of Nebraska with physician concurrence, determine that inpatient care is no longer necessary.