1. Read this notice carefully and ask questions if you understand it. It tells you don’t about your rights as a hospital patient, including: Your right to receive Medicare-covered services during and after your hospital stay, as ordered by your doctor. This includes the right to know what these services are, who will pay for them, and where you can get them. Your right to be involved in any decisions about your hospital stay, and know who will pay for it. Where to report any concerns you have about quality of your hospital care. Your right to appeal your discharge decision if you think you are being discharged from the hospital too soon. Legal Terms The written notice from Medicare tells you how you can an “request Requesting an immediate review is a formal, immediate review.” legal way to ask for a delay in your discharge date so that we will cover your hospital care for a longer time. (Section 7.2 below tells you how you can request an immediate review.) 2. You must sign the written notice to show that you received it and understand your rights. You or someone who is acting on your behalf must sign the notice. (Section 4 of this chapter tells how you can give written permission to someone else to act as your representative.) Signing the notice shows that you have received the information about your only rights. The notice does not give your discharge date (your doctor or hospital staff will tell you your discharge date). Signing the notice does mean you are agreeing on not a discharge date. 3. Keep your copy of the signed notice so you will have the information about making an appeal (or reporting a concern about quality of care) handy if you need it. If you sign the notice more than two days before the day you leave the hospital, you will get another copy before you are scheduled to be discharged. To look at a copy of this notice in advance, you can call Member Services (phone numbers are printed on the back cover of this booklet) or 1-800 MEDICARE 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also see it online at .
1. Read this notice carefully and ask questions if you don’t understand it. It tells you about your rights as a hospital patient, including: Your right to receive Medicare-covered services during and after your hospital stay, as ordered by your doctor. This includes the right to know what these services are, who will pay for them, and where you can get them. Your right to be involved in any decisions about your hospital stay, and know who will pay for it. Where to report any concerns you have about quality of your hospital care. Your right to appeal your discharge decision if you think you are being discharged from the hospital too soon. Legal Terms The written notice from Medicare tells you how you can “request an immediate review.” Requesting an immediate review is a formal, legal way to ask for a delay in your discharge date so that we will cover your hospital care for a longer time. (Section 7.2 below tells you how you can request an immediate review.) 2. You must sign the written notice to show that you received it and understand your rights. You or someone who is acting on your behalf must sign the notice. (Section 4 of this chapter tells how you can give written permission to someone else to act as your representative.) Signing the notice shows only that you have received the information about your rights. The notice does not give your discharge date (your doctor or hospital staff will tell you your discharge date). Signing the notice does not mean you are agreeing on a discharge date. 3. Keep your copy of the signed notice so you will have the information about making an appeal (or reporting a concern about quality of care) handy if you need it. If you sign the notice more than two days before the day you leave the hospital, you will get another copy before you are scheduled to be discharged. To look at a copy of this notice in advance, you can call Member Services (phone numbers are printed on the back cover of this booklet) or 1-800 MEDICARE 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also see it online at .
H4093_ISNP_HMO_NONPOS_Model_wRx_v2-PA_EOC.docx