Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
SEPTEMBER 1998 NICA NEWS
GOLD RECORDS
Record #37 1/98 (Volunteer L. Martin) The client wanted to appeal the decision that Medicare made regarding his hospital stay and the use of his lifetime reserve days. All MSNs were sorted through and the appeal was generated. Our volunteer called for assistance from the Regional Representative as well as from the NICA office. Medicare denied the appeal.Time=5 hours 5 minutes, $0, Satisfied=Yes.
When you are an inpatient in the hospital, written notice may be given to you stating your coverage is terminated by Medicare because hospitalization is no longer medically necessary. However, if you wish to appeal this decision, you have until noon the following day to request a review by The Sunderbruch Corporation- Nebraska (TSCN). TSCN has until the following day after receiving your medical record to reach a decision. If the decision is in your favor, you may remain in the hospital and Medicare will cover the cost of your care until it is medically appropriate for you to be discharged to a different level of care. If the decision is not in your favor, in most cases, you would not become financially responsible until the day after you receive TSCN's review decision.
When filing an appeal, keep all your original documents; mail in the copies. Keep all records pertaining to the situation for two years as well as maintain any additional information that may be of value in supporting the claim.
Call TSCN's Medicare Consumer Helpline at 1-800-247-3004 with your questions. You may also call the HelpLine to request TSCN's free consumer newsletter, Medicare Today.