Medicare beneficiaries have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers.
One of your rights as a Medicare beneficiary is to request an expedited review of the discontinuation of Medicare covered services. Staff is available seven days a week including holidays, from 8:00 a.m. – 5:00 p.m. to take your requests for appeals. A physician will review your medical records and Mountain-Pacific will call you with the results of that review.
Appealing a discharge notice - If you are in the hospital and have been told you are ready to go home (discharged) and believe you are not ready to leave, you have the right to request an appeal. Please call 1-800-497-8232. Once we hear from you, we will have a physician review your medical records to determine if you are ready for discharge.
Hospital pre-admission/admission appeals - If you were planning on being admitted to a hospital and receive a pre-admission notice of noncoverage stating that your care will not be covered, you can request a review immediately but no later than three calendar days after you receive the notice. Call our toll-free helpline at 1-800-497-8232.
Non-hospital setting appeals - If you are in a skilled nursing facility, have home health care, hospice or comprehensive outpatient rehabilitation and are told that Medicare will not continue to pay for your skilled services, you can ask for an expedited appeal. Call our toll-free helpline at 1-800-497-8232.