How to Fight A Hospital Discharge

You Can Appeal Your Discharge

Doctor writing notes while talking to male patient : Stock Photo CompEmbedShareAdd to Board Caption:Female doctor writing notes while talking to male patient in hospital ward Doctor writing notes while talking to male patient
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About the only aspect of leaving a hospital that is consistent among all patients is that we all do it sooner or later. Hospital discharge is the process by which you prepare to, then leave the hospital.

In an ideal world, hospital discharge would take place when both you and your doctor think the time is right. You would be strong enough and healthy enough to handle not only the important discharge tasks and details, but also to take care of yourself once you arrive at your destination.

However, we don’t live in an ideal world. In order to understand why problems arise with the timing of hospital discharge, and what can be done about it, we need to understand how the decision is made about the amount of time you’ll be hospitalized.

Why Discharge Is Your Payer’s Decision

Before we are admitted to the hospital, our entire hospitalization and any predicted tests, procedures and treatments, must be approved for payment by our payers - our insurance company or public payer such as Medicare, Tricare, the VA or state Medicaid payer.

To determine what they will pay for, payers rely on diagnostic codes, called ICD codes, and procedure (service) codes called CPT codes to describe what is wrong with you, and therefore what treatment or tests need to be performed to help you. Included in those descriptions are the average amount of time you are approved to be in the hospital to complete the tasks that fall under those codes.

Of course, what “average” means is anyone’s guess. It’s based on the insurance company's opinion on what the ideal patient, someone with no additional problems, would need. It’s not at all based on individual patients and their status.

Therefore, based on the those anticipated codes that have been assigned to you, once your time is up, your payer will no longer pay for your stay.

If they won’t pay, then unless you can pay cash, the hospital will send you home. Therefore, your date and time of discharge are not based on physical readiness. They are based on coded payments which may be in direct conflict with your readiness.

Why Should Patients Stay Hospitalized Longer?

Problems will crop up if you aren’t “average.” Maybe your body is having trouble healing from surgery. It’s possible you’ve gotten a hospital infection, or have been the victim of a drug error.  Older people take longer to get back on their feet. 

For these reasons and others, you or your doctor may determine that the payer allotted time won’t be enough time for you. If there has been an additional problem (like the infection or a drug error), the hospital may automatically try to extend payment for your stay, and you won’t ever hear about it. But that does not always happen.

There are money reasons for you to want to stay an extra day or two, too.  For example, if you need to be discharged to a skilled nursing center or rehab, Medicare won’t pay for it unless you’ve stayed at least three days.

  So you may be caught in a bind.  What is wrong with you – based on your diagnostic code – may mean they’ll pay for only two days. But if you are discharged in two days, you may be stuck with the cost of the other facility – possibly for months or years.

What Are the Reasons You Should NOT Want to Stay Longer?

It’s also possible your reluctance to leave isn’t based on your health status at all; rather it’s about the lack of caregiving support you have at home, or even just fear that without someone monitoring you 24/7, that something major could happen that would go unnoticed. Maybe you are just lonely and you like the attention you get in the hospital.

The truth is, in most cases, these are not good enough reasons to stay.

Why? Because hospitals are dangerous places. Only the sickest of patients are found in hospitals, and along with them are found the worst of infectious agents which are too easy to contract.

Infections also rear their very ugly heads when the hospital personnel who care for you – doctors, nurses and others – don’t work diligently to stop their spread, which they can do by washing their hands and taking other steps to keep you safe.

Further, we know that hundreds of thousands of Americans die in hospitals every year, not from the reason they were hospitalized to begin with; rather because something that happened during their hospital stay killed them.

If you decide to fight your hospital discharge, be sure it’s because it’s absolutely necessary for your survival and does not put you at further risk from these kinds of hospital problems.

Staying Longer May Cost You More

As you consider filing an appeal, don’t forget that staying longer may cost you out of your pocket more, too.  You may have co-pays, deductibles and co-insurance you’ll owe to the hospital for the extension.

Make the Appeal so You Can Stay in the Hospital

Once you’ve been given a discharge date and you and your doctor agree that you should extend your stay, you will want to appeal (fight) the discharge date you’ve been given.

The steps for appealing the discharge date will vary from hospital to hospital, and from state to state unless you are a Medicare patient. Medicare has a very specific process to follow no matter where you live or what hospital you’ve been admitted to.

Those guidelines may also be used by the hospital for non-Medicare patients, so if you decide to appeal and you aren’t a Medicare patient, you can attempt to try to follow their instructions anyway.

Here are some generalities that may be helpful to you no matter who your payer is:

  1. Most hospitals provide you with lots of paperwork when you are admitted.  Included should be a statement of your rights, which should also include information about your discharge and how to appeal a discharge.  If you aren’t provided with a notice of discharge and how to file an appeal, request one from the hospital's patient advocate or representative. Then follow those guidelines.
  2. The person you will be appealing to is called a “QIO” which stands for Quality Information Officer.  The federal government has strict requirements for the way a QIO handles discharge appeals.
  3. “Safe Discharge” is the key term Medicare uses, and you can use it, too.  When you file your appeal, make sure to state that you don’t believe the current discharge plan meets the needs of “Safe Discharge” as defined by Medicare, even if you are not a Medicare patient.  Just using the terminology may mean the decision will be favorable to you. You can learn more about the requirements of safe discharge here.

The Hospital May Help You Fight the Discharge

Keeping in mind that hospitals only make money when their beds are full, there will be circumstances when they want to go to bat for you to help keep you there. Of course, the longer you stay, the more money they make.  Therefore, you may be able to depend on them to convince your payer to keep you there.

In addition, new laws passed in the past few years have provided for penalties that will affect a hospital’s income if problems arise from a too-early discharge. Learn more about those penalties here.

Whatever you decide, be sure it's in the best interest of your health and medical status and that the stress of the process doesn't have a negative effect on you.

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