How to File an Appeal

Hospital Observation Appeals

If you have Original Medicare (not a Medicare Advantage Plan), you have the right to appeal if a hospital changes your status from inpatient to outpatient under observation. This change matters because it can affect how much you pay and whether Medicare will cover care in a skilled nursing facility after you leave the hospital.

You should get a notice from the hospital called a Medicare Change of Status Notice (MCSN). This notice explains the change and your right to ask for a review. However, you do not need to receive the notice before contacting us. If you believe you should have been listed as an inpatient, call us right away to request an appeal. Acentra Health will have a doctor review your medical records to see if you should have been listed as an inpatient, based on Medicare guidelines. This service is free and part of your Medicare rights.

Contact Acentra Health

To speak with a representative about filing an appeal, click on the link below for the phone number for your state.

Telephone Numbers

Immediate Advocacy Discharge Assistance

This process applies only to Medicare patients with Original (Fee-for-Service) Medicare who call Acentra Health regarding a hospital discharge appeal.

Worried About Leaving the Hospital Too Soon?

Have you or someone you care for been told you are leaving the hospital soon, but you don’t feel ready? This can be confusing and stressful. Help is available.

Immediate Advocacy Discharge Assistance helps with concerns about leaving the hospital. This service is for people who:

• Have Original Medicare
• Are staying in an acute care hospital
• Have been told that a discharge is planned

Immediate Advocacy Discharge Assistance can:

• Explain your discharge plan in simple, clear words
• Help you talk with hospital staff and case managers
• Make sure your questions and concerns are shared and understood

This service gives you extra support during a difficult time.

Immediate Advocacy Discharge Assistance does not take away your right to appeal a discharge and does not change appeal deadlines. It is meant to help you understand what is happening, not replace the appeal process.

Immediate Advocacy Discharge Assistance works with the hospital to help with communication. However, they cannot look at medical records, decide if care is medically needed, or promise to change the discharge date. The goal is to help you understand what is happening, know your choices, and feel supported during the discharge process.

You or someone helping you can contact Acentra Health to ask for Immediate Advocacy Discharge Assistance.

• Contact information is on hospital discharge notices
• You can call our Helpline.

Leaving the hospital can feel overwhelming, especially if you don’t feel ready. Immediate Advocacy Discharge Assistance is here to listen, answer your questions, and help make sure your concerns are heard.

Contact Acentra Health

To speak with a representative about Immediate Advocacy Discharge Assistance, click on the link below for the phone number for your state.

Telephone Numbers

Denial of Coverage from a Medicare Advantage Plan

If you have a Medicare Advantage plan, you have some additional Medicare rights. If you are concerned that you cannot get the care you need, you have the right to appeal to the Medicare Advantage plan. You can appeal things like denials for:

• Referrals to a specialist;
• Approval for tests (like x-rays or blood tests); and
• Payment of a bill.

The Medicare Advantage plan has information about how to start the appeal process. If you feel you may get worse by waiting too long, you can ask for an expedited appeal. This means the Medicare Advantage plan must make a decision about the appeal within three calendar days. If you need this faster review, ask your Medicare Advantage plan for an “expedited appeal.”

For additional information about a denial of coverage, call 1-800-MEDICARE.

For additional information about asking for medical records, please complete a Medical Record Request.