Appealing an Impending Discharge or Termination of Service

Act Quickly

If you have been notified that your inpatient hospital care (see the sidebar for information about "inpatient" vs. "observation" hospital stays) or other medical services such as rehabilitation, nursing home, home health, or hospice care is about to end, and you believe that you still need these services, it is important to begin the appeal process quickly. This process only applies to patients with Medicare coverage.

For Care Provided in Idaho or Washington

Call Qualis Health’s Appeals Helpline at 877-290-4346.

• You may leave a message at any time, on any day. If you call outside of our normal business hours (8:00am to 4:30pm Pacific Time, 7 days a week), our paging service will relay your request as soon as possible.
• In your message, be sure to provide the patient’s name and Social Security number, the name of the healthcare facility, and a phone number where you can be reached.

Qualis Health will discuss your situation with you or your designate, then contact the facility. We will request your medical record, then assign an independent physician to review the documentation and determine whether it is medically necessary to continue your current course of treatment. We will notify you and your healthcare provider of our decision right away.

For Care Provided Outside of Idaho or Washington

To receive assistance, please call 1-800-MEDICARE (1-800-633-4227) or TTY/TTD 1-877-486-2048 for the hearing and speech impaired.

Be Prepared

Any Medicare beneficiary or authorized representative (for example, family member, legal guardian, or caregiver) can request an appeal. Please be sure to share this information with your family.

You can also take simple steps to prepare yourself for a discharge from a healthcare facility (and avoid a return visit).