MPRO Home: Medicare Consumers: How to Appeal

How to Appeal

Talk to your doctor about your stay in the hospital.

Note for Managed Care Plans

If you are a patient who is enrolled in a managed care plan such as an HMO you may receive a Notice of Discharge and Medicare Appeal Rights. If you receive this Notice, you can appeal to MPRO by noon of the next business day. If you miss this appeal timeframe, you can still appeal but not to MPRO. Your appeal would then be through your health plan.

You and your doctor know more about your condition and your health needs than anyone else. If you have any questions about your medical treatment, your need for continued hospital care, your discharge, or your need for possible post-hospital care, don’t hesitate to ask your doctor. The hospital’s patient representative or social worker will also help you with your questions and concerns about hospital services.

Ask a patient representative to give you the decision to release you in writing.

This is called a Notice of Non-coverage. You must have a written Notice of Non-coverage to appeal.

Call MPRO at 1-800-365-5899 by noon of the NEXT business day.

For example, if you receive your notice on Monday, you have until noon on Tuesday to call MPRO. If you call within this timeframe, you will not have to pay for the days you stayed in the hospital during the MPRO review. If you are not able to call in this timeframe, you can still appeal, but you will have to pay for the additional days if MPRO disagrees with you and decides continued hospitalization is not needed.

MPRO Will Review Your Condition

While you are in the hospital, MPRO will review your condition to see if you need to stay in the hospital. You can not be sent home or billed by the hospital until MPRO completes the review of your case.

MPRO will review your case by speaking with you and the hospital representative. We will obtain a copy of your medical record to determine if you are being discharged before you are medically ready. We will inform you of our decision when the review is complete. If MPRO finds that you do not need hospital care any longer, Medicare will not pay for your continued stay in the hospital, and you will be responsible for the hospital bill for the rest of your stay.