Patients & Visitors

How to Request Notice of No Coverage

If the Notice of Noncoverage states that your physician agrees with the Medical Center’s decision:

You must make your request for review to the PRO by noon of the first working day after you receive the Notice of Noncoverage by contacting the PRO by phone. The PRO will ask for your views about your case before making its decision. The PRO will inform you by phone and in writing of its decision on the review. If the PRO agrees with the Notice of Noncoverage, you may be billed for all costs of your stay beginning at noon of the day after you receive the PRO’s decision. Thus, you will not be responsible for the cost of hospital care before you receive the PRO’s decision.

If the Notice of Noncoverage states that the PRO agrees with the hospital’s decision:

You may request reconsideration by the PRO immediately upon receipt of the Notice of Noncoverage by contacting the PRO by phone or in writing. The PRO can take up to three working days from receipt of your request to complete the review. The PRO will inform you in writing of its decision on the review. Since the PRO has already reviewed your case once, prior to the issuance of the Notice of Noncoverage, the hospital is permitted to begin billing you for the cost of your stay beginning with the third calendar day after you receive your Notice of Noncoverage even if the PRO has not completed its review. Thus, if the PRO continues to agree with the Notice of Noncoverage, you may have to pay for at least one day of hospital care. Note: The process described above is called “immediate review.” If you miss the deadline for this immediate review while you are in the hospital, you may still request a review of Medicare’s decision to no longer pay for your care at any point during your hospital stay or after you have left the hospital. The Notice of Noncoverage will tell you how to request this review.