Important Message from Medicare about your rights (hospital discharge)

Dear Harold Vance, This letter is about your stay at Maury Regional Hospital. Please read it carefully. **Your rights as a patient** - You can get services that Medicare covers. This includes hospital care that you need for your health. You have the right to know which services are covered. - You can work with the hospital to get ready to leave safely. The hospital can also help you set up any care you will need after you go home. If you have questions or worries, you can talk with your doctor or other hospital staff. - If you have concerns about the care you are getting, you can contact the group that checks the quality of hospital care. It is called Midsouth Quality Review. Call them at 1-888-555-0142. This group is separate from Medicare. **If you think you are being sent home too soon** - You can ask to appeal. An appeal means asking someone to look again at the decision. You can do this right away. - To appeal, call Midsouth Quality Review at 1-888-555-0142. - Ask for your appeal as soon as you can, and before you leave the hospital. If you ask before you leave, Medicare will keep paying for your hospital stay while you wait for the decision. - If you ask for an appeal, Midsouth Quality Review will look at your records. They will give you their decision in about 2 days. - You can still appeal after you leave the hospital. If you have Original Medicare, call Midsouth Quality Review at 1-888-555-0142. If you have a Medicare Advantage plan, call your plan at Volunteer Advantage Plan at 1-877-555-0175. **What happens after you appeal** - If you appeal, you will get another paper called a Detailed Notice of Discharge. It explains why the hospital thinks your covered stay should end. - If the appeal decision is in your favor, Medicare will keep paying for your hospital care. - If you do not appeal, or if the decision is not in your favor, you may have to pay for care you get after your discharge date. **Please sign this letter** to show that you got it and understand it. Signature of patient or representative: ____________ Date and time: ____________ **Other help you can get** You have the right to get Medicare information in a format that is easier to read or hear, such as large print, braille, or audio. You also have the right to file a complaint if you feel you were treated unfairly. For more information, visit Medicare.gov/about-us/accessibility-nondiscrimination-notice or call 1-800-MEDICARE (1-800-633-4227). If you use a TTY, call 1-877-486-2048. **Questions?** You can call Maury Regional Hospital at 931-555-0118. The address is 1224 Trotwood Avenue, Columbia, TN 38401.

**Maury Regional Hospital** 1224 Trotwood Avenue, Columbia, TN 38401 Phone: 931-555-0118 **Patient:** Harold Vance # An Important Message from Medicare ## Your Rights as a Hospital Patient - **Medicare helps pay for your care.** This includes hospital care that you need for your health. You have the right to know what Medicare covers. - **You can help plan your trip home.** The hospital will work with you to make sure it is safe for you to leave. They can also help set up any care you may need after you go home. If you are worried about anything, talk to your doctor or the hospital staff. - **You can report problems with your care.** If you are not happy with the quality of your care, call this group: Midsouth Quality Review at 1-888-555-0142. This group is not part of Medicare. It is separate. ## You Can Appeal if You Are Sent Home Too Soon An appeal is a way to ask for a second look at a decision. - If you think the hospital wants you to leave too soon, you can appeal right away. - To appeal, call Midsouth Quality Review at 1-888-555-0142. - Call as soon as you can. Be sure to call **before you leave the hospital**. If you appeal before you leave, Medicare will keep paying for your stay while you wait to hear the answer. - If you appeal, the group will look at your records. They will tell you their answer in about 2 days. - You can still appeal after you leave the hospital. - If you have Original Medicare, call Midsouth Quality Review. - If you have a Medicare Advantage plan, call your plan. Your plan is Volunteer Advantage Plan. The phone number is 1-877-555-0175. ## What Happens After I Appeal? - You will get another letter called the **Detailed Notice of Discharge**. It tells you why the group thinks you no longer need to stay in the hospital. - If the answer is **yes** (they agree with you), Medicare will keep paying for your hospital care. - If you **do not appeal**, or if the answer is **no**, you may have to pay for any care you get after your discharge date. ## Please Sign Sign below to show that you got this letter and understand it. Signature of patient or helper: ____________ Date and time: ____________ ## Help and Fairness - You can ask for Medicare information in another form. Choices include large print, braille, or audio. - If you feel someone treated you unfairly, you have the right to make a complaint. - To learn more, go to Medicare.gov/about-us/accessibility-nondiscrimination-notice. You can also call 1-800-MEDICARE (1-800-633-4227). - If you use a TTY phone, call 1-877-486-2048.

Patient name: Harold Vance Hospital name: Maury Regional Hospital Hospital address: 1224 Trotwood Avenue, Columbia, TN 38401 Hospital phone number: 931-555-0118 ## An Important Message from Medicare ## Your Rights While You Are Staying in the Hospital - Medicare pays for some of your care. This includes hospital care that your doctor says you need. You have the right to know what Medicare will pay for. - You can work with the hospital to plan for when you go home. This helps you leave safely. The hospital can also help you set up any care you need after you leave. If you are worried about anything, talk to your doctor or another hospital worker. - Do you have a problem with the care you are getting? You can tell a group that checks on hospital care. This group is called a Quality Improvement Organization. Yours is Midsouth Quality Review. Call them at 1-888-555-0142. This group is not part of Medicare. ## You Can Ask for a Review If You Think You Are Leaving Too Soon - Leaving the hospital is called being "discharged." If you think the hospital is sending you home too soon, you can ask for a review right away. This is called an "appeal." - To ask for a review, call Midsouth Quality Review at 1-888-555-0142. - Call as soon as you can. Try to call before you leave the hospital. If you call before you leave, Medicare will keep paying for your stay while you wait for an answer. - Midsouth Quality Review will look at your records. They will give you an answer about 2 days after you call. - You can still ask for a review after you leave the hospital. - If you have Original Medicare, call Midsouth Quality Review at 1-888-555-0142. - If you have a Medicare Advantage plan, call Volunteer Advantage Plan at 1-877-555-0175. ## What Happens After I Ask for a Review? - You will get another letter. It is called the "Detailed Notice of Discharge." It will tell you why the hospital and your plan think your stay should end. - If the review goes your way, Medicare will keep paying for your hospital care. - If you do not ask for a review, or if the review does not go your way, you may have to pay for care you get after the day you were supposed to leave. Please sign below. Your signature shows that you got this letter and understand it. Signature of patient or person helping the patient: ____________ Date and time: ____________ You can get Medicare information in a way that is easier for you to use. This includes large print, braille, or audio. If you feel you have been treated unfairly because of who you are, you have the right to complain. To learn more, go to Medicare.gov/about-us/accessibility-nondiscrimination-notice. Or call 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing and use a TTY phone, call 1-877-486-2048.

**An Important Message from Medicare** **Patient:** Harold Vance **Hospital:** Maury Regional Hospital **Address:** 1224 Trotwood Avenue, Columbia, TN 38401 **Phone:** 931-555-0118 --- **Your Rights in the Hospital** - Medicare pays for the care you need in the hospital. You have the right to know what care Medicare pays for. - You can work with the hospital to plan for going home safely. You can also set up any help you may need after you leave. If you are worried, talk to your doctor or the hospital staff. - If you are worried about the care you get, you can tell a group called the Quality Improvement Organization. It does not work for Medicare. Here is how to reach it: - Midsouth Quality Review - Phone: 1-888-555-0142 --- **You Can Appeal If You Have to Leave the Hospital** An appeal is when you ask for a decision to be looked at again. - Do you think you are being sent home too soon? You can appeal right away. - To appeal, call Midsouth Quality Review at 1-888-555-0142. - Call as soon as you can. Call before you leave the hospital. If you call before you leave, Medicare will keep paying while you stay and wait for the answer. - If you appeal, the group will look at your records. They will tell you their answer in about 2 days. - You can still appeal after you leave the hospital. - If you have Original Medicare, call Midsouth Quality Review. - If you have a Medicare Advantage plan, call your plan. Your plan is Volunteer Advantage Plan. The phone number is 1-877-555-0175. --- **What Happens After I Appeal?** - You will get another letter. It is called the Detailed Notice of Discharge. It tells you why your hospital stay should not keep being paid for. - If the answer is good for you, Medicare will keep paying for your hospital care. - If you do not appeal, or if the answer is not good for you, you may have to pay for care you get after your leave date. --- **Please Sign Here** Sign to show that you got this letter and understand it. Signature of patient or helper: ____________ Date and time: ____________ --- **Help Reading This Letter** You can ask for Medicare information in other ways, such as large print, braille, or audio. If you think you were treated unfairly, you can make a complaint. - Website: Medicare.gov/about-us/accessibility-nondiscrimination-notice - Phone: 1-800-MEDICARE (1-800-633-4227) - TTY phone: 1-877-486-2048

**Important Message from Medicare** **Patient:** Harold Vance **Hospital:** Maury Regional Hospital **Address:** 1224 Trotwood Avenue, Columbia, TN 38401 **Phone:** 931-555-0118 --- ## Your Rights as a Hospital Patient - **You can get care that Medicare covers.** This includes hospital care you need for your health. You have the right to know which services Medicare will pay for. - **You can help plan your safe discharge.** Discharge means leaving the hospital. You can work with the hospital to set up any care you may need after you go home. If you have worries, talk to your doctor or other hospital staff. - **You can report concerns about your care.** Call your Quality Improvement Organization (a group that checks on the quality of care). It is separate from Medicare. - **Midsouth Quality Review: 1-888-555-0142** ## You Can Appeal Your Discharge An appeal is a request to have the decision looked at again. - If you think you are being sent home too soon, you can appeal right away. - To appeal, call Midsouth Quality Review at **1-888-555-0142**. - Ask for an appeal **as soon as you can, and before you leave the hospital.** If you do, Medicare will keep paying for your hospital stay while you wait for the answer. - If you appeal, the Quality Improvement Organization will review your records. You should get its decision about **2 days** after you ask. - You can still appeal after you leave the hospital. - If you have **Original Medicare**, call Midsouth Quality Review. - If you have a **Medicare Advantage plan**, call your plan: **Volunteer Advantage Plan, 1-877-555-0175.** ## What Happens After I Appeal? - You will get another notice called the **Detailed Notice of Discharge**. It explains why the reviewers think your hospital stay should not continue. - **If you win your appeal,** Medicare will keep paying for your hospital care. - **If you don't appeal, or if you lose your appeal,** you may have to pay for any care you get after your discharge date. ## Please Sign Sign below to show that you got this notice and understand it. Signature of patient or representative: ____________________ Date and time: ____________________ ## Help and Fairness - You have the right to get Medicare information in a way that works for you, such as large print, braille, or audio. - If you feel you were treated unfairly because of who you are, you have the right to file a complaint. - To learn more, visit **Medicare.gov/about-us/accessibility-nondiscrimination-notice** or call **1-800-MEDICARE (1-800-633-4227)**. - TTY users (for people with hearing or speech needs) can call **1-877-486-2048**.

**Important Message from Medicare** **For:** Harold Vance **Hospital:** Maury Regional Hospital **Address:** 1224 Trotwood Avenue, Columbia, TN 38401 **Hospital phone:** 931-555-0118 **Your Rights as a Hospital Patient** - You have the right to get the services Medicare covers. This includes hospital care that you need for your health. You have the right to know which services are covered. - You can work with the hospital to plan for a safe discharge. Discharge means leaving the hospital. You can also plan for any care you may need after you leave. If you are worried about anything, you can talk to your doctor or other hospital staff. - You can report worries about the quality of your care. Call your Quality Improvement Organization: **Midsouth Quality Review, 1-888-555-0142**. This group is separate from Medicare. **You Can Appeal Your Discharge** An appeal is a way to ask for a second look at a decision. - If you think the hospital is sending you home too soon, you can appeal right away. - To appeal, call Midsouth Quality Review at **1-888-555-0142**. - Ask for the appeal as soon as you can. You should ask **before you leave the hospital**. If you appeal before you leave, Medicare will keep covering your care while you wait in the hospital for the answer. - If you appeal, Midsouth Quality Review will look at your records. They will give you their decision about **2 days** after you ask for the appeal. - You can still appeal after you leave the hospital. - If you have **Original Medicare**, call Midsouth Quality Review at 1-888-555-0142. - If you have a **Medicare Advantage plan**, call your plan. Your plan is Volunteer Advantage Plan. The number is **1-877-555-0175**. **What Happens After You Appeal?** - You will get another notice called the **Detailed Notice of Discharge**. It tells you why your covered hospital stay should not go on. - If the decision is good for you, Medicare will keep paying for your hospital care. - If you do not appeal, or if the decision is not good for you, you may have to pay for care you get after your discharge date. **Please Sign** Sign below to show that you got this notice and understand it. Signature of patient or person acting for the patient: ____________ Date and time: ____________ **Other Help and Your Rights** - You have the right to get Medicare information in a form that works for you. Choices include large print, braille, or audio. - You have the right to make a complaint if you feel you were treated unfairly because of who you are. - To learn more, go to Medicare.gov/about-us/accessibility-nondiscrimination-notice. Or call 1-800-MEDICARE (1-800-633-4227). - If you use a TTY, call 1-877-486-2048.

# An Important Message from Medicare **Patient:** Harold Vance **Hospital:** Maury Regional Hospital **Hospital address:** 1224 Trotwood Avenue, Columbia, TN 38401 **Hospital phone:** 931-555-0118 ## Your Rights as a Hospital Patient - You can get services that Medicare covers. This includes hospital services you need for your health. - You have the right to know which services are covered. - You can work with the hospital to get ready to leave safely. You can also plan for any services you may need after you leave. - If you have worries about leaving the hospital, you can talk to your doctor or other hospital staff. - If you have worries about the quality of your care, you can tell your Quality Improvement Organization. Here is who to call: - Midsouth Quality Review - 1-888-555-0142 - Quality Improvement Organizations are independent of Medicare. This means they do not work for Medicare. ## You Can Appeal Your Hospital Discharge An appeal is a way to ask for a review of the decision. If you think you are being sent home too soon, you can appeal right away. **How to appeal** - Call your Quality Improvement Organization: - Midsouth Quality Review - 1-888-555-0142 - Ask for an appeal as soon as you can. Do it before you leave the hospital. - If you appeal before you leave, you will have coverage while you wait in the hospital for the decision. **How long it takes** - The Quality Improvement Organization will look at your records. - It will give you its decision about 2 days after you ask for an appeal. **If you have already left the hospital** - You can still appeal. - If you have Original Medicare, call your Quality Improvement Organization. - If you have a Medicare Advantage plan, call your plan: - Volunteer Advantage Plan - 1-877-555-0175 ## What Happens After I Appeal? - You will get another notice. It is called the Detailed Notice of Discharge. It explains why your covered hospital stay should not continue. - If the decision is good for you, Medicare will keep covering your hospital services. - If you do not appeal, you may have to pay for services you get after your discharge date. - If you appeal and the decision is not good for you, you may also have to pay for services you get after your discharge date. ## Please Sign Sign below to show you got this notice and understood it. Add the date and time. Signature of patient or representative: ____________ Date/Time: ____________ ## Getting Help and Fair Treatment - You have the right to get Medicare information in a way that works for you. This includes large print, braille, or audio. - You have the right to file a complaint if you feel you were treated unfairly. - To learn more, visit Medicare.gov/about-us/accessibility-nondiscrimination-notice. You can also call 1-800-MEDICARE (1-800-633-4227). - If you use a TTY, call 1-877-486-2048.