2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 9: What to do if you have a problem or complaint (coverage decisions, appeals, complaints) 214 · Explaining its decision. · Notifying you of the right to a Level 3 appeal if the dollar value of the drug coverage you are requesting meets a certain minimum. If the dollar value of the drug coverage you are requesting is too low, you cannot make another appeal and the decision at Level 2 is final. · Telling you the dollar value that must be in dispute to continue with the appeals process. Step 4: If your case meets the requirements, you choose whether you want to take your appeal further. · There are three additional levels in the appeals process after Level 2 (for a total of five levels of appeal). · If you want to go on to a Level 3 appeal the details on how to do this are in the written notice you get after your Level 2 appeal decision. · The Level 3 appeal is handled by an Administrative Law Judge or attorney adjudicator. Section 9 in this chapter tells more about Levels 3, 4, and 5 of the appeals process. Section 7 How to ask us to cover a longer inpatient hospital stay if you think you are being discharged too soon When you are admitted to a hospital, you have the right to get all of your covered hospital services that are necessary to diagnose and treat your illness or injury. During your covered hospital stay, your doctor and the hospital staff will be working with you to prepare for the day when you will leave the hospital. They will help arrange for care you may need after you leave. · The day you leave the hospital is called your “discharge date.” · When your discharge date is decided, your doctor or the hospital staff will tell you. · If you think you are being asked to leave the hospital too soon, you can ask for a longer hospital stay and your request will be considered. Section 7.1 During your inpatient hospital stay, you will get a written notice from Medicare that tells about your rights Within two days of being admitted to the hospital, you will be given a written notice called An Important Message from Medicare about Your Rights. Everyone with Medicare gets a copy of this notice. If you do not get the notice from someone at the hospital (for example, a caseworker or nurse), ask any hospital employee for it. If you need help, please call Customer Service or 1-800- MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY 1-877-486-2048). 1. Read this notice carefully and ask questions if you don’t understand it. It tells you: