As Medicare patients, you have rights
that the federal government requires hospitals to observe. You should know
about these rights and know what to do if a hospital does not observe them.
WHAT
IS REQUIRED UPON ADMISSION TO A HOSPITAL?
The law requires that
hospitals give a Discharge Procedure Information Form upon admission to all
Medicare patients. This form:
a. states
that a patient's discharge date should be determined by medical needs and not
by
Medicare payments;
b. informs
the patient of his/her right to appeal discharge while in the hospital if the
patient feels he/she is being asked to leave the hospital too soon;
c. gives
information necessary to make this appeal.
WHAT
IS A NOTICE OF NON-COVERAGE?
The hospital is
required to give a denial notice if it is determined that a patient no longer
requires inpatient care and the attending physician agrees.
a.
The denial notice does not
mean you must leave the hospital. It only means that Medicare will not continue
coverage.
b.
The denial notice must be
given to the patient and not to the patient's next of kin unless the patient is
expected not to understand the notice.
c.
The denial notice must be in
writing and must inform you of your right to appeal the hospital's
determination.
d.
The patient can request that
the Peer Review Organization (PRO) review the hospital decision. You cannot be
made to pay for your hospital care until the PRO makes its decision. You must
make your request to the PRO for a review by noon of the first working day
after you receive the notice. You can do this by phone or in writing.
e.
If the Peer Review
Organization upholds the hospital's decision, the patient is entitled to
Reconsideration by the PRO if a written request is submitted within 60 days.
f.
The hospital may not charge
you if you continue to stay unless a written denial notice is provided.
WHAT
IS DISCHARGE PLANNING?
A Medicare patient
has the right to a discharge plan or discharge planning services if it is
likely that the patient will suffer adverse health consequences without such
planning.
a.
The hospital must provide a
discharge plan for patients identified above and for other patients upon
request.
b.
The discharge plan must
include provision for the patient's likely need for appropriate post hospital
services and the availability of those services. Post_hospital services include
home health care.
c.
The discharge plan must be
developed under the supervision of a registered nurse, social worker or other
qualified personnel and discussed with the patient (or the patient's
representative).
d.
Only a physician can request
that a discharge plan be developed and implemented, therefore it is important
to discuss your discharge plan with your physician.
HOW
DO I PROTECT MY RIGHTS?
Remember to read
carefully all hospital documents that claim to explain your Medicare rights.
Do not allow a
relative or third person to sign any guarantee of payment to the hospital on
your behalf.
All documents should
be given to you for your review.
Question
your doctors, nurses, social workers, and other health care providers about the
care and service you will need after you leave the hospital.
Request discharge
planning services as early as possible.
If you feel you are being asked to leave
the hospital too soon it may help to complain to the hospital administration
about the hospital's failure to provide adequate discharge planning.
ASIDE
FROM MY RIGHTS TO DISCHARGE PLANNING, DO I HAVE ANY OTHER RIGHTS AS A HOSPITAL
PATIENT?
Yes, whether you are
a Medicare patient or not, everyone has some basic rights as hospital patients.
Some of these rights include:
a. The
right to receive accurate and complete information regarding your diagnosis,
treatment and prognosis. The information must be expressed in terms you can
understand.
b. The
hospital must get your informed consent prior to any procedure or treatment you
receive. Informed consent means that you understand why a particular procedure
or treatment is being performed and that you are aware of and understand all
possible risks and benefits associated with it.
c. The
right to refuse any treatments offered to you. If you decide to refuse
treatment you must be informed of the potential consequences and effects
refusing treatment may have on your health.
d. The
right to request a second opinion from another physician.
e. The
right to leave the hospital against medical advice. You may leave the hospital
at any time even if your doctor advises you to stay for a longer period of
time. If you wish to leave against medical advice, however, you must receive
information as to the consequences and potential adverse effects of doing so.
You will also be required to sign a form relieving the hospital of liability if
you do leave.
f.
The right to refuse to
participate in research. Many hospitals are involved in research projects,
especially university or teaching hospitals. Sometimes this research involves
treating patients with new or unconventional treatments or procedure. You are
not required to participate in medical research and have a right to refuse to
take part in medical research. If you do chose to participate you must give
informed consent and may refuse to continue to participate at any time.
g. The
right to have all information and records related to your care kept
confidential. You also have the right to put limits on those persons who may
visit you while you are hospitalized.
h. The
right to examine your hospital bill and receive an explanation of the charges.
i.
The right to make Advance
Medical Directives and have your choices regarding medical treatment honored by
the hospital staff. Upon admission, the hospital is required to ask you if you
have made Advance Directives and if you have not must give you the opportunity
to make them. An Advance Directive is a statement that makes your choices about
medical treatment known in advance of an incapacitating illness. You may also
name someone to make decisions for you should you become incapable of deciding
for yourself. For more information about Advance Directives in Virginia contact
the Legal Services branch near you to obtain a brochure on Advance Directives.
If you feel that:
a.
You have been discharged
from a Medicare hospital 1) too soon or 2) without the necessary post hospital
services having been arranged; OR
b.
Your rights as a hospital
patient have been violated; you should contact the Legal Services branch office
near you. The telephone numbers are listed below.
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