Hospital Patient's Rights
IPRO contracts with the federal government to evaluate and improve care provided to people on Medicare and to ensure their rights.
All Medicare beneficiaries are protected by rights whether you are in the original Medicare plan or another Medicare health plan.
You Have the Right to:
- Be treated with dignity and respect at all times.
- Be protected from discrimination.
- Get information about Medicare that you can understand to help make health care decisions.
- Have your questions about Medicare answered.
- Culturally competent services.
- Get emergency care where and when you need it.
- Learn about all your treatment choices in clear language that you can understand.
- File a complaint about the quality of care you received, payment issues and access to services.
- Appeal decisions relating to your claims and benefits.
- Have your health information that Medicare collects about you kept private.
In The Hospital You Should Also:
- Receive all the hospital care you need.
- Receive a written discharge plan.
- Exercise your right to appeal if you are given a written Notice of Non-Coverage stating that Medicare will no longer cover your care.
- Speak to a hospital patient representative to help you understand any notices you receive.
Before You Go to The Hospital You Should:
- Plan ahead by speaking to your doctor about your condition and knowing what to expect.
- Understand your Medicare hospital coverage. Call 1-800-MEDICARE to ask questions about your coverage and your rights.
- Take a family member or a friend in the event that you need additional support understanding your treatment needs and rights.
At the Time of Admission to the Hospital You Should:
- Ask for the "Important Message from Medicare." It describes your rights and how to appeal.
At the Time of Discharge
If you are told that Medicare will not pay for continued days of care in the hospital you should:
- Ask for all notices of non-coverage in writing. The notice you should get is called a "Hospital Issued Notice of Non-Coverage."
- People in Medicare Advantage (MA) plans must use the MA appeals process to appeal admission denials but can use IPRO's process or the MA process for hospital appeals of continued stay denials.
- Speak to your doctor and other caregivers about your discharge plan.
- If you disagree with the hospital discharge and you choose an IPRO review you must call IPRO at 1-800-331-7767 before noon of the next working day after you receive the notice of discharge.
- If you use the MA appeal process to appeal your in-patient stay, time frames are longer and you may incur costs for days of care.
If you lose the appeal, the hospital can bill you from noon of the day after you get IPRO's decision. The next level of appeal is called a "reconsideration". Always ask about additional appeal rights.
If you receive a Notice of Non-Coverage and miss the deadline for appeals, you can still request a review at any time during your hospital stay or after you are home.
If you receive a notice and do not request a review, the hospital may bill you for all the costs of your stay beginning with the third day after you receive the Notice of Non-Coverage. If you are in an exempt hospital or unit and you receive a notice you must call immediately if you wish to appeal. The hospital can bill you the day after you receive the notice.
Expedited Non-Coverage Reviews - Beneficiaries may call IPRO's Non-Coverage Department upon receipt of a Hospital Issued Notice of Noncoverage, for a review of their care. All Medicare patients, including managed care enrollees, are entitled to a review of their medical stability as evidenced by the medical record, with protection against premature discharge, and an assurance that an adequate, safe patient discharge plan has been formulated and that the patient has been properly informed about their discharge rights. The review also identifies patient liability for payment, and describes further appeal rights.
For more information about Medicare Hospital Patient's Rights, call the IPRO Helpline at:
1-800-331-7767
or write to IPRO at:
IPRO Attn: Medicare/Federal Health Care Assessment
1979 Marcus Avenue
Lake Success, New York 11042
The quality of medical care you receive is important to us. Please call our helpline at the number listed above if you have questions about the quality of services you received in any of the following settings: hospitals, doctors' offices, ambulatory surgery centers, home health agencies, skilled nursing facilities, hospital emergency rooms and outpatient areas, as well as in managed care organizations.
Resources
- CMS Medicare Helpline 1-800-MEDICARE or 1-800-633-4227, TTY/TDD 1-877-486-2048, Web site: www.Medicare.gov
- IPRO Non-Coverage Department (Hospital Appeals) 1-800-446-2447 (New York State only) or other calls 1-800-326-6131
- Social Security Administration 1-800-772-1213
- Medicare Fraud Hotline 1-800-447-8477
- Health Now (Durable Medical Equipment) 1-800-633-4227
- Palmetto GBA (Railroad Retirement) 1-800-833-4455
- Empire Medicare Services Part A & B (Downstate) 1-800-633-4227
- Group Health Insurance Queens Only 1-800-633-4227
- Empire Health Now Upstate Counties 1-800-633-4227
- Health Insurance Information Counseling and Assistance Program (New York City)1-800-701-0501
- New York State Insurance Department (Medigap) 1-800-342-3736
- New York State Office for Aging 1-800-342-9871
- United Government Services (Home Health or Hospice Questions) 1-800-633-4227