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Hospital Admission

If your doctor believes that you need to be admitted to a Utah or Nevada hospital, but the hospital has doubts that you require this acute level of medical care, you may appeal that decision to HealthInsight, the Medicare Quality Improvement Organization. Please note that this is a right for persons with Original Medicare; it does not apply for those enrolled in Medicare Advantage (formerly Medicare+Choice) HMO plans. When this happens, the hospital will send you a letter called an “admission denial.” It basically says that the hospital does not think Medicare will pay for your stay because it is not medically necessary.

HealthInsight’s telephone number will be on the admission denial letter from the hospital. It is your responsibility to call and ask for a free review. When reviewing your case, the HealthInsight representative will speak with your doctor and the hospital. We will also obtain a copy of your medical record to determine if you are being wrongly denied admission to a hospital. We will inform you of our decision when the review is complete. If we determine the admission is medically necessary, Medicare will pay for your stay. If the Medicare QIO agrees with the Hospital, Medicare will not pay for your hospital stay.

Utah or Nevada Medicare Beneficiary Hotline: 800-748-6773