MPRO Home: Medicare Consumers: Denied Admission

Denied Admission

Managed Care Plans

The regular appeal process only applies to standard Medicare, not managed care plans, such as HMOs. If you have a plan other than standard Medicare, you must appeal to your plan, not MPRO. Here are the general telephone numbers for those HMOs who provide services to Michigan's Medicare beneficiaries.

HealthPlus (800) 332-9161

Health Alliance Plan
(800) 422-4641

Paramount (Toledo, OH)
(800) 462-3589

UniCare - www.unicare.com

You and your doctor may be notified by a hospital representative that Medicare will not pay for your scheduled hospitalization. You have a right to appeal that decision through MPRO.

Here’s how:

Ask for and receive a written Notice of Non-coverage. This is a letter from the hospital denying you admission to the hospital because they think your admission is not medically necessary, and they think Medicare will not pay for the hospitalization. You must have a written Notice of Non-coverage to appeal.
Talk to your doctor. Your doctor may be able to provide additional information to the hospital that may affect your admission.
Call MPRO at 1-800-365-5899 and appeal immediately if you and/or your doctor disagree with the hospital’s decision not to admit you.

If you choose to appeal, MPRO will review your case to determine if there is a medically sound reason for your admission. MPRO will speak with you, your doctor and the hospital. We will obtain a copy of your medical record to determine if you are being wrongfully denied admission to a hospital. We will inform you of our decision when the review is complete.

MPRO can overturn the hospital’s decision and approve your admission when there is a clear medical need for your hospitalization. If MPRO overturns the hospital’s decision, Medicare will pay for your hospital bill. If MPRO agrees with the hospital’s decision not to admit you, then Medicare will not pay for your hospitalization. You can still be admitted to the hospital, but you will be responsible for your hospital bill.

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Compare Quality of Care at Hospitals Compare Quality fo Care at Nursing Homes Compare Quality of Care at Home Health Agencies Quality of Care Complaints What is Mediation? Learn Your Medicare Rights Have You Been Denied Admission? Have You Been Asked to Leave the Hospital Too Soon? How To Appeal Health Topics Who to Call Contact Info Medicare Consumers Home Additional Links MPRO Home	MPRO Home: Medicare Consumers: Denied Admission Denied Admission Managed Care Plans The regular appeal process only applies to standard Medicare, not managed care plans, such as HMOs. If you have a plan other than standard Medicare, you must appeal to your plan, not MPRO. Here are the general telephone numbers for those HMOs who provide services to Michigan's Medicare beneficiaries. HealthPlus (800) 332-9161 Health Alliance Plan (800) 422-4641 Paramount (Toledo, OH) (800) 462-3589 UniCare - www.unicare.com You and your doctor may be notified by a hospital representative that Medicare will not pay for your scheduled hospitalization. You have a right to appeal that decision through MPRO. Here’s how: Ask for and receive a written Notice of Non-coverage. This is a letter from the hospital denying you admission to the hospital because they think your admission is not medically necessary, and they think Medicare will not pay for the hospitalization. You must have a written Notice of Non-coverage to appeal. Talk to your doctor. Your doctor may be able to provide additional information to the hospital that may affect your admission. Call MPRO at 1-800-365-5899 and appeal immediately if you and/or your doctor disagree with the hospital’s decision not to admit you. If you choose to appeal, MPRO will review your case to determine if there is a medically sound reason for your admission. MPRO will speak with you, your doctor and the hospital. We will obtain a copy of your medical record to determine if you are being wrongfully denied admission to a hospital. We will inform you of our decision when the review is complete. MPRO can overturn the hospital’s decision and approve your admission when there is a clear medical need for your hospitalization. If MPRO overturns the hospital’s decision, Medicare will pay for your hospital bill. If MPRO agrees with the hospital’s decision not to admit you, then Medicare will not pay for your hospitalization. You can still be admitted to the hospital, but you will be responsible for your hospital bill.

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Denied Admission

Managed Care Plans