Medicare and Your Rights

Learn about your rights as a Medicare patient.

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Medicare and your rights

As a hospital patient, you have the right to: 

  • Receive Medicare covered services. This includes medically necessary hospital services and services you may need after you are discharged, if ordered by your doctor. You have a right to know about these services, who will pay for them and where you can get them. 

  • Be involved in any decisions about your hospital stay, and know who will pay for it. 

  • Report any concerns you have about the quality of care you receive to the Quality Improvement Organization (QIO) listed here: 

The QIO for both Oregon and Washington is KEPRO: 1-888-305-6759 or  TTY 1-855-843-4776

Your Medicare discharge rights 

Planning for your discharge: During your hospital stay, the hospital staff will be working with you to prepare for your safe discharge and arrange for services you may need after you leave the hospital. When you no longer need inpatient hospital care, your doctor or the hospital staff will inform you of your planned discharge date. 

If you think you are being discharged too soon: 

  • You can talk to the hospital staff, your doctor and your managed care plan (if you belong to one) about your concerns. 

  • You also have the right to an appeal, that is, a review of your case by a Quality Improvement Organization (QIO). The QIO is an outside reviewer hired by Medicare to look at your case to decide whether you are ready to leave the hospital.

    • If you want to appeal, you must contact the QIO no later than your planned discharge date and before you leave the hospital. 

    • If you do this, you will not have to pay for the services you receive during the appeal (except for charges such as co-pays and deductibles). 

    • If you do not appeal but decide to stay in the hospital past your planned discharge date, you may have to pay for any services you receive after that date.

To speak with someone at the hospital about this notice, call: 

  • Legacy Emanuel Medical Center: 503-413-4103 
  • Legacy Good Samaritan Medical Center: 503-413-7629 
  • Legacy Meridian Park Medical Center: 503-692-7430 
  • Legacy Mount Hood Medical Center: 503-674-1340 
  • Legacy Salmon Creek Medical Center: 360-487-5050 
  • Legacy Silverton Medical Center: 503-873-1596 
  • Unity Center for Behavioral Health: 503-944-8023

 

Steps to appeal your discharge

Step 1 
You must contact the QIO no later than your planned discharge date and before you leave the hospital. If you do this, you will not have to pay for the services you receive during the appeal (except for charges like co-pays and deductibles). 

The QIO for both Oregon and Washington is KEPRO: 1-888-305-6759 or  TTY 1-855-843-4776

You can file a request for an appeal any day of the week. Once you speak to someone or leave a message, your appeal has begun. Please ask the hospital if you need help contacting the QIO. You will need to provide the QIO with the name and number of the Legacy hospital you are calling about: 

  • Legacy Emanuel Medical Center: 1831112358 
  • Legacy Good Samaritan Medical Center: 1780608216 
  • Legacy Meridian Park Medical Center: : 1184647620 
  • Legacy Mount Hood Medical Center: 1255354700 
  • Legacy Salmon Creek Medical Center: 1700809829 
  • Legacy Silverton Medical Center:  1669424354
  • Unity Center for Behavioral Health: 003822487 (adults), 1245773225 (adolescents) 
     

Step 2 
You will receive a detailed notice from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think you are ready to be discharged. 

Step 3 
The QIO will ask for your opinion. You or your representative need to be available to speak with the QIO, if requested. You or your representative may give the QIO a written statement, but you are not required to do so. 

Step 4 
The QIO will review your medical records and other important information about your case. 

Step 5 
The QIO will notify you of its decision within one day after it receives all necessary information. 

  • If the QIO finds you are not ready to be discharged, Medicare will continue to cover your hospital services. 
  • If the QIO finds you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of its decision. 

If you miss the deadline to appeal, you have other appeal rights: 

You can still ask the QIO or your plan (if you belong to one) for a review of your case:

  • If you have Original Medicare: Call the QIO listed above. 
  • If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.  
  • If you stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date. 

For more information, call 1-800-MEDICARE (1-800-633-4227), or TTY: 1-877-486-2048. 

Medicare Version Date 03/31/2020 

**See Patient Relations for additional information about how to let Legacy know if you have a problem or concern, as well as for the contact information for the Quality Improvement Organizations for Oregon and Washington. 

Notice of beneficiary financial liability for our Medicare beneficiaries 

Legacy Health is an integrated health care delivery system, with hospitals and clinics throughout the Portland-Vancouver metropolitan area and mid-Willamette Valley. 

Some of the clinics are considered “hospital-based” since they share a license with a Legacy hospital. Others are considered “free-standing.”  

The services or procedures you get at Legacy’s hospital-based clinics may include a facility charge as well as a physician charge. As the facility charge only applies to hospital-based clinics, you may pay more for certain outpatient services and procedures given at our hospital-based clinics than you would at our free-standing clinics.