You may be receiving care from a nursing home, outpatient rehabilitation facility, hospice, or home health agency. You may be told that care is no longer needed. As a result, Medicare will no longer cover your services or stay. If this happens, you will be given a Notice of Medicare Provider Non-Coverage. This document must be given to you at least two days before the services being provided will be stopped.

Before You File an Appeal

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• Talk to your doctor. Your doctor may explain why the care is no longer required. You may be able to get other kinds of care.

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• Make sure you have a written notice that explains why your services/stay are no longer covered. The notice also shows the date that your Medicare coverage ends.

Making the Appeal 

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• Call the HQSI Medicare Beneficiary Helpline at 1-800-624-4557 no later than noon of the day before the last covered day to file an appeal. (TTY users should call 1-800-752-8420.) Once you speak to someone at HQSI or leave a message, your appeal has begun.

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• Helpline hours are from 8:30 am to 5:00 pm Monday through Friday. You can leave a message after hours. An HQSI associate will get back to you as soon as possible, but no later than the next day.

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• Once your appeal is made, HQSI will request information from your provider. HQSI will review the information and make a decision. You cannot be sent home or billed for services until the review of your case is completed. We will notify you and your healthcare provider about the decision first by phone, followed by written notification of the decision.

Outcome of Appeal

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• If HQSI does not agree that your services/stay should end, Medicare will continue to pay. You will only be responsible for your deductible, coinsurance, and non-covered items.

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• If HQSI does agree that your Medicare services/stay should end, Medicare will not continue to pay.