Emergency guide
I'm being sent home from hospital, or someone I care for is
Being told you are going home, or that someone you love is, can feel sudden. If you have Medicare in the US, there is a fast appeal: ask before you leave to keep the most protection. You can still appeal after you leave, with less protection. The clocks below say how. In the UK, the official pages give no appeal against a discharge date. But if going home is not safe, you can say so today, and you can complain: this page says what to ask for and how. Below are what to ask today, the dates that may have started, who to call and what to say.
General information, not legal advice. Rules depend on where you live. If you have a letter, notice or form with a date on it, get advice before that date passes.
Checked 10 October 2026 · re-check due 10 April 2027 · To keep a copy, use your browser’s print or share menu.
First: are you safe?
If anyone is in danger now, or the person who is ill looks much worse, call 911 in the US or 999 in the UK before anything else. The NHS says 999 is for life-threatening emergencies such as strokes and heart attacks. If you are home and not sure it is an emergency, call the number the hospital gave you for problems. In England and Wales you can also call NHS 111. In Scotland, call 111 (NHS 24). Northern Ireland has no 111: call your GP, or the GP out-of-hours service when the surgery is closed. If caring for someone, or being sent home, has you thinking about ending your life, call or text 988 in the US, or call Samaritans on 116 123 in the UK, at any hour. If there is no food in the house tonight, call 211 in the US; in the UK, a food bank needs a voucher first: Trussell, below, says how to get one.
Today
- If it is not safe to go home yet, tell the nurse in charge today. In England, guidance says no one should be discharged until it is safe; Northern Ireland's says not before the services you need are arranged. Say why: no one at home, stairs, falls, medicines, a wound, or not being able to cook or wash. Ask for the plan for getting home, in writing.
- If the person coming home cannot take in what is being decided, tell the ward today, in writing. Ask staff to check whether they can decide for themselves and whether it is safe for them to be alone. Ask for an independent advocate (someone who speaks up for them).
- US, with Medicare: if you do not feel ready to leave the hospital, call your QIO (the independent Medicare reviewer) before you leave. Its number is on the paper called the Important Message from Medicare. No copy? Ask the nurse. Signing the paper only shows you got it. Calling is free, but if the QIO agrees with the hospital and you stay, you may be billed for the days after.
- US, with Medicare: if a nursing facility, home health agency or hospice says Medicare is ending your care, call the QIO as soon as you get the notice. Its number is on the paper called the Notice of Medicare Non-Coverage. No copy? Ask the provider. If the QIO agrees with them and you stay, you may be billed for the days after. The clocks below say when.
- US: ask the nurse, 'Am I an inpatient, or here on observation?' Observation does not count as an inpatient stay, and Medicare may not pay for a nursing facility afterwards. If your status changed, ask for the Medicare Change of Status Notice.
- UK: ask who is in charge of your going home, and for the plan: how you get home, who visits, which medicines and equipment you take, and who to call if something goes wrong. You and your carers can take part in making the plan.
- Before you leave, ask for these in writing: your medicines and how to take them, your follow-up appointments, whom to call with a question, and whom to call for a serious problem. The US government's guide for leaving hospital has a place for each.
- US: if you need home health care or a nursing facility, ask for the hospital's list of ones near you, and say which you choose. The federal rule says the hospital must give you a list and tell you the choice is yours.
- US: ask whether Medicare will pay for a nursing facility: it has rules about the days you spent in hospital and how soon you go in. The clock below has them.
- UK: if you will need help at home, ask for a care needs assessment. In England the NHS says it is free and anyone can ask. Ask your council's adult social services (social work in Scotland); in Northern Ireland, your HSC Trust. It may be done after you are home.
- If you look after the person who is coming home, ask for your own carer's assessment too (in Scotland, an Adult Carer Support Plan). In England you can ask for it to be done at the same time as theirs.
- UK: before you agree a care home place or pay anything, ask for the fees and the contract in writing. The Competition and Markets Authority says you should get the terms upfront and enough time to consider the final offer.
- In England, guidance says that, other than in exceptional circumstances, no one should go straight from hospital into a permanent care home for the first time without a chance to recover somewhere temporary first: ask whether that comes first.
- England: the NHS says the short-term care it offers to help you recover after hospital (called intermediate care) is free. It lasts only while you need it and usually ends after a short time; you may have to pay for care after that. If you are asked to pay for care straight after hospital, ask why, in writing, before you agree.
- UK: you can say which care home you want. Scotland and Northern Ireland say you have the right to choose. In England and Wales, if the council arranges the place, it must give you a real choice; in Wales it must give its reasons in writing if it says no.
- UK: a home that costs more than the council or Trust will pay can mean you or a relative pay the difference: ask what the extra would be, and who has to pay it, before you choose.
- US: read a nursing home admission paper before you sign it. The home must not make someone else guarantee payment, and you do not have to sign an arbitration agreement (giving up going to court) to get in. If you sign for someone else, check you are not agreeing to pay their bill yourself.
The clocks that have started
Deadlines that can start when this happens, soonest first. Your own letters give your dates; when two dates could apply, count from the earlier one. The details of each are on the page online; its address is at the bottom.
Deadlines that can start when this happens, soonest first. Tap one to see when it starts and what happens if you miss it. Your own letters give your dates; when two dates could apply, count from the earlier one.
Jump to: United States · United Kingdom
In the United States
Told you must leave the hospital, and you have Medicare? Call the QIO for a fast appeal before you goCall your QIO (Quality Improvement Organization, the independent Medicare reviewer named on the Important Message from Medicare) before you leave the hospital.United States (federal rule)
- How long
- Call your QIO (Quality Improvement Organization, the independent Medicare reviewer named on the Important Message from Medicare) before you leave the hospital. The paper says to ask before you leave; the federal rule says no later than the day of discharge. Use the earlier: before you leave. You can ask by phone or in writing.
- Starts
- the day the hospital tells you that you are being discharged. Within 2 days of your admission and before you are discharged you should get a paper called the Important Message from Medicare (the IM): if you have not been given it, ask for it. Count from the day you are told, which can be today.
- If missed
- you can still ask the QIO, but the protection from the hospital bill no longer applies and you may have to pay for the days you stay after the discharge day. If you are still in the hospital, the QIO decides about 2 days after you ask. If you have already left, you can ask the QIO within 30 days of the day you left, or later if you have a good reason, and it decides within 30 days. If you have a Medicare Advantage plan and miss the QIO deadline, ask your plan for a fast appeal; the protection from the bill does not apply there either.
- It lets you
- stay in the hospital while the QIO decides. The hospital has to prove to the QIO that discharge is the right decision, and the QIO decides within about 1 day of getting the information it needs. If you ask in time, you do not pay for the hospital stay while you wait (except your coinsurance and deductible) until noon of the day after the QIO tells you its decision. If the QIO agrees with the hospital, you may have to pay for hospital services you get after that time. If the QIO disagrees, Medicare keeps covering the stay for as long as it is medically necessary (except your coinsurance and deductible).
Where this differs: This clock is for Medicare, Original Medicare and Medicare Advantage alike. With a Medicare Advantage plan, Medicare covers the stay after a decision in your favour if the plan approved the admission or it was emergency or urgently needed care; otherwise you may need to appeal to your plan too. If the hospital changed you from inpatient to outpatient 'getting observation services', Original Medicare gives a separate fast appeal: the paper called the Medicare Change of Status Notice says how, and it is best to ask while you are still in the hospital. Know what it can cost: if the QIO decides your status should not have changed, you owe the Part A inpatient hospital deductible, and you may then qualify for a Medicare-covered nursing facility stay within 30 days of leaving. If it decides the change was right, you owe the Part B costs (the full outpatient cost if you have no Part B) and Medicare will not pay for a nursing facility afterwards. The notice shows both. The QIO is run by Commence Health or Acentra Health depending on your state: use the number on your paper. If you do not have Medicare, this clock does not apply: look in your Medicaid notice or insurance papers for your dates.
Checked 10 October 2026 at Medicare.gov (Centers for Medicare & Medicaid Services)
Might you need a nursing facility after hospital? Medicare pays only if you go in soon after you leaveBefore you leave, ask the hospital team: 'Will Medicare pay for a nursing facility for me?' Medicare pays for skilled nursing facility care only after a qualifying inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, not counting the day you leave).United States (federal rule)
- How long
- Before you leave, ask the hospital team: 'Will Medicare pay for a nursing facility for me?' Medicare pays for skilled nursing facility care only after a qualifying inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, not counting the day you leave). You must also enter the facility within a short time, generally 30 days, of leaving the hospital, and need skilled care related to your hospital stay.
- Starts
- the day you leave the hospital after an inpatient stay. Time in hospital as an outpatient, under observation or in the emergency room before you were admitted does not count toward the inpatient days Medicare needs.
- If missed
- Medicare will not pay for the facility. Ask the hospital team or your doctor whether you can get care in another setting, such as home health care, or from another program such as Medicaid. If your status was changed from inpatient to observation, see the appeal on the hospital clock.
- It lets you
- have Medicare cover skilled nursing facility care when you meet all the conditions. If you leave the facility and go into the same or another one within 30 days, you do not need another 3-day hospital stay.
Where this differs: Some doctors belong to an Accountable Care Organization with a waiver of the 3-day rule, and some Medicare Advantage plans waive it too: ask your doctor, the hospital, or your plan. Medicaid and private insurance have their own rules: read your plan papers.
Checked 10 October 2026 at Medicare.gov: Skilled nursing facility (SNF) care
Medicare is ending your nursing facility, home health, rehab or hospice care? Call the QIO for a fast appeal by noon the day after you get the noticeCall your QIO (Quality Improvement Organization, the independent Medicare reviewer named on the notice) by noon of the day after you get the notice.United States (federal rule)
- How long
- Call your QIO (Quality Improvement Organization, the independent Medicare reviewer named on the notice) by noon of the day after you get the notice. The federal rule says noon of the calendar day after you receive it; Medicare.gov and the notice say no later than noon the day before the date your coverage ends. When the two differ, use the earlier. You can ask by phone or in writing.
- Starts
- the day you get a paper called the Notice of Medicare Non-Coverage (the NOMNC). The provider should give it to you at least 2 days before your covered services end. If you have not been given it, ask for it. Count from the day you get it, which can be today.
- If missed
- the QIO still accepts your request and decides as soon as it can, but the 72-hour time frame and the protection from charges do not apply. This is the same with a Medicare Advantage plan; you can also ask your plan for a fast appeal. The notice says: if you miss the deadline you may still have appeal rights, so call the QIO.
- It lets you
- have an independent review of whether your care should end. Your services continue until the date and time on the notice unless the QIO reverses the decision, and the provider may not bill you for the disputed services until the review (and the next review, if you ask for it) is finished. The QIO must decide within 72 hours of getting your request. If the QIO says the care should end, you will not owe for care before the end date on the notice, and you may owe for care after it. Stopping the services by the end date on the notice keeps you clear of that risk. For home health or outpatient rehabilitation (CORF), the QIO also needs a doctor to say in writing that stopping may put your health at significant risk. Ask for the appeal first: the QIO tells you how to get it.
Where this differs: This clock is for skilled nursing facility care, home health, outpatient rehabilitation (CORF) and hospice, under Original Medicare or a Medicare Advantage plan. In a hospital, including an inpatient rehabilitation hospital, use the hospital fast appeal. Medicaid and private insurance have their own notices and dates: read the notice. If a nursing home is moving you out for another reason, such as non-payment, see the nursing home notice clock.
Checked 10 October 2026 at Centers for Medicare & Medicaid Services rules, 42 CFR 405.1202 (Cornell Legal Information Institute copy)
The QIO said the care should end? Ask for the next review by noon the next dayAsk the QIC (Qualified Independent Contractor, the next independent reviewer) to look again by noon of the calendar day after the QIO tells you its decision.United States (federal rule)
- How long
- Ask the QIC (Qualified Independent Contractor, the next independent reviewer) to look again by noon of the calendar day after the QIO tells you its decision. You can ask by phone or in writing. The QIO's written decision says how.
- Starts
- the day the QIO tells you its decision, by phone or in writing. If it tells you by phone first, count from that call.
- If missed
- you can still ask for an ordinary appeal, but the fast time frames and the protection from charges while it runs no longer apply. The QIC's written decision says how to appeal further and by when.
- It lets you
- have a new reviewer look at your case. The QIC must decide within 72 hours of getting your request and the records it needs, unless you ask for more time (up to 14 days). If you ask by the deadline, the provider may not bill you for the disputed services until the QIC decides.
Ask for this the same day the QIO tells you its decision.
Where this differs: This follows a QIO decision under Original Medicare in a nursing facility, home health, outpatient rehabilitation or hospice setting, or in the hospital if you are still there. If you have left the hospital, the QIO's letter gives the ordinary appeal and its date. With a Medicare Advantage plan, the next step is to ask the same reviewer to look again, within 60 days of its decision; care after the end date is at your cost unless the decision is reversed. The QIO's written decision says how.
Checked 10 October 2026 at Centers for Medicare & Medicaid Services rules, 42 CFR 405.1204 (Cornell Legal Information Institute copy)
A nursing home says you must leave? Get the notice in writing and appeal by the date on itRead the written notice today and appeal by the date it gives, or as soon as you can: the date on the notice comes first.United States (federal rule)
- How long
- Read the written notice today and appeal by the date it gives, or as soon as you can: the date on the notice comes first. The nursing home must give the notice at least 30 days before it moves or discharges you, except in the cases the rule lists. The notice must say why, the date, where you are going and how to appeal.
- Starts
- the day the nursing home gives you, or the person who represents you, the written notice. The home must also send a copy to the state long-term care ombudsman (a free advocate for people who live in nursing homes).
- If missed
- if you think the date to appeal has passed, call the long-term care ombudsman or legal aid before you decide it has. The home may not discharge you for any reason it likes: the rule lists the allowed reasons, and the notice must state the reason it uses.
- It lets you
- If you went into hospital from the nursing home and it now says you cannot come back, that counts as a discharge: the home must give you the same written notice, and you can appeal it. If your hospital stay ran past the home's bed-hold period, the rule says you return to your old room if it is free, or to the first free bed in a shared room, if you still need the home's care and qualify for Medicare skilled nursing or Medicaid nursing facility care. Appeal using the steps in the notice. It must say who receives appeal requests, and how to get an appeal form and help filling it in. If you appeal, the home may not move or discharge you while the appeal is pending, unless not moving you would put the health or safety of you or others in danger, and then it must document that danger. The notice must also give the name, address and phone number of the state long-term care ombudsman: call it the same day.
Where this differs: Notice may be shorter, 'as soon as practicable', when others' safety or health is in danger, when your health has improved enough for an earlier move, when your urgent medical needs require it, or when you have lived in the home for less than 30 days. If the home is closing, it must give written notice before it closes and a plan for moving residents. Appeals and hearings are run by your state: the notice gives the date and the address, and the date on the notice comes first. Medicaid is run by your state too. This federal rule covers nursing homes that take Medicare or Medicaid (skilled nursing facilities and nursing facilities). Assisted living and board and care homes are not covered by it: your state's rules apply, so ask the long-term care ombudsman. Before you sign an admission paper for a nursing home, know that this same rule says the home must not require a third party guarantee of payment as a condition of admission; it may ask a representative who has legal access to the resident's money to sign a contract to pay from that money, without becoming personally liable for the bill.
Checked 10 October 2026 at Centers for Medicare & Medicaid Services rules, 42 CFR 483.15 (Cornell Legal Information Institute copy)
In the United Kingdom
England: ask whether anyone will check if the NHS should pay for long-term care (NHS continuing healthcare)Ask the hospital team, your GP or social services whether a continuing healthcare checklist will be done, and when.England only
- How long
- Ask the hospital team, your GP or social services whether a continuing healthcare checklist will be done, and when. The NHS says the ICB will normally decide within 28 days of getting a completed checklist or a request for a full assessment.
- Starts
- the day the ICB (integrated care board, the local NHS body that decides) gets a completed checklist, or a request for a full assessment. Ask the ward or social services whether a checklist will be done and when, and ask for the date it was sent in writing. National guidance says the checklist is usually done after you leave hospital, once you have had time to recover, so this clock may not start before you go home.
- If missed
- if the answer is no, ask the ICB in writing for a review as soon as you can, and keep the date on its decision letter. The national framework names no time limit for asking, but some ICBs ask for a review request within 6 months of the date on the decision letter, so do not wait. Each ICB must publish its own review process with timescales, and the decision letter should explain it. If that does not settle it, you can ask NHS England for an independent review: ask the ICB, in writing, what the time limit is for that step and keep every letter's date. If you are not eligible but need nursing care in a registered care home, the NHS may still pay part of it (NHS-funded nursing care). Beacon gives free independent advice on 0345 548 0300.
- It lets you
- get a decision on whether the NHS pays for all of your health and social care, in your home or a care home. If the ICB says you are eligible but took longer than 28 days and the delay was unjustifiable, it should refund your care costs from the 29th day until its decision. If you are nearing the end of your life and getting worse quickly, ask for the fast-track pathway: the care package should be put in place as soon as possible, usually within 48 hours. National guidance says the assessment should not delay you leaving hospital, and that interim support should carry on, with no gap, until the decision is made.
Where this differs: England only. Wales has its own Continuing NHS Healthcare (CHC) framework: the Welsh Government page says the health board decides and you can ask hospital staff, social services or your GP for a checklist, and it states no number of days. In Northern Ireland, nidirect says the HSC Trust applies for Health Service continuing care for you if staff think you are eligible. This clock does not apply in Scotland: ask the hospital team and your council what NHS-funded care may be open to you.
Checked 10 October 2026 at NHS (nhs.uk): NHS continuing healthcare
Scotland: unhappy with how you or someone you love was sent home? Complain within 6 monthsComplain within 6 months to the NHS board that ran the hospital, by phone or in writing.Scotland
- How long
- Complain within 6 months to the NHS board that ran the hospital, by phone or in writing. The Patient Advice and Support Service (PASS) can help you complain.
- Starts
- the day it happened, to be safe. The rule counts 6 months from when the matter came to your notice, but not more than 12 months after it happened.
- If missed
- the 6 months can be extended if the feedback and complaints officer considers it reasonable in the circumstances. Ask anyway, and say why you are late.
- It lets you
- have the board look into what happened and reply. If you are still unhappy, the Scottish Public Services Ombudsman (SPSO) is the final stage: it must not consider a complaint made more than 12 months after you first had notice of the matter, unless it is satisfied there are special circumstances.
Where this differs: Scotland only. England, Wales and Northern Ireland each have their own complaints clock. The Scottish Government's page says you can complain if you think the NHS has treated you unfairly or the plans it made for you are wrong.
Checked 10 October 2026 at mygov.scot: Help if you're leaving hospital
Northern Ireland: unhappy with how you or someone you love was sent home? Complain within 6 monthsComplain as soon as you can, within 6 months, to the complaints manager of the Health and Social Care (HSC) Trust that ran the hospital.Northern Ireland
- How long
- Complain as soon as you can, within 6 months, to the complaints manager of the Health and Social Care (HSC) Trust that ran the hospital. You do not have to wait: you can speak to the staff dealing with your care. The Patient and Client Council gives free support to make a complaint.
- Starts
- the day it happened, to be safe. nidirect counts 6 months from when you became aware you had a cause for complaint, and normally no longer than 12 months after the event.
- If missed
- the Trust and NIPSO may still look at a late complaint in special circumstances. Ask anyway, and say why you are late.
- It lets you
- have the Trust look into it and reply; it should acknowledge your complaint within two or three working days. If you are not happy with the Trust's final answer, you can refer the complaint to the Northern Ireland Public Services Ombudsman (NIPSO). When the Trust's complaints process ends, the law says it must send you a letter, within 2 weeks, saying so, telling you that you can go to NIPSO, and giving the time limit. You then have 6 months from the day that letter is sent: keep it and its date. NIPSO can still investigate if there are special circumstances.
Where this differs: Northern Ireland only. England, Wales and Scotland each have their own complaints clock. You can complain on someone else's behalf, but you will generally need their consent.
Checked 10 October 2026 at nidirect: How to complain or raise concerns about health services
England: unhappy with how you or someone you love was sent home? Complain within 12 monthsComplain within 12 months to the NHS body that provided the care, such as the hospital's complaints team, or to the council about its care assessment.England only
- How long
- Complain within 12 months to the NHS body that provided the care, such as the hospital's complaints team, or to the council about its care assessment. PALS (the Patient Advice and Liaison Service) can tell you how, and can find you independent help to complain.
- Starts
- the day it happened, or if later the day you first knew there was something to complain about. To be safe, count from the day it happened.
- If missed
- the NHS body can still look at a late complaint if you had good reasons for the delay and it is still possible to investigate fairly and effectively. Ask anyway.
- It lets you
- have the NHS body or council look into what happened and reply. If you are still unhappy with the NHS reply, you can complain to the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman), which asks you to complain to it within 12 months of knowing about the issue. For a complaint about the council's care assessment, or about a care home or home care agency, the council or provider comes first and the Local Government and Social Care Ombudsman is the final stage; it normally cannot look at a complaint more than 12 months after you first knew about the problem.
Where this differs: England only. Wales, Scotland and Northern Ireland each have their own complaints clock, below. The NHS website says you can complain if you feel it was unsafe to leave hospital, or the information or support you were given when leaving did not match your expectations.
Checked 10 October 2026 at legislation.gov.uk: The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, regulation 12
Wales: unhappy with how you or someone you love was sent home? Raise a concern within 12 monthsRaise your concern within 12 months, with the staff involved or with the concerns team of your health board or NHS trust.Wales
- How long
- Raise your concern within 12 months, with the staff involved or with the concerns team of your health board or NHS trust. Llais (the independent citizens' voice body) gives free, confidential help to raise a concern.
- Starts
- the day it happened, or if later the day you first knew about it. To be safe, count from the day it happened.
- If missed
- if more than 12 months have passed and there are good reasons for the delay, the concerns team may still be able to look into it. Ask anyway. The law sets an outer limit: a concern cannot be raised 3 years or more after it happened or came to your notice.
- It lets you
- have the NHS body look into it and reply; it aims to reply within 30 working days and tells you if it needs longer. Since 1 April 2026 this process is called Listening to People. If you are not happy with the reply, you can go to the Public Services Ombudsman for Wales. The Welsh Government's leaflet says to do this within 12 weeks of receiving the reply; the Ombudsman's own site says within a year of knowing about the issue. To be safe, contact the Ombudsman within 12 weeks of the reply. You can raise a concern yourself, or a carer, friend or relative can do it for you if you agree.
Where this differs: Wales only. England, Scotland and Northern Ireland each have their own complaints clock. A concern raised up to 31 March 2026 stays under the older Putting Things Right process, with the same 12 months. For a GP, dentist, pharmacist or optician, start with the practice, or ask your health board to look into it.
Checked 10 October 2026 at Welsh Government: How to raise a concern about NHS Wales (Listening to People leaflet)
Who to call
Jump to: United States · United Kingdom
In the United States
Your state's Medicare QIO (fast appeals: Acentra Health or Commence Health)
if the hospital says you must leave, or Medicare says care in a nursing facility, at home, in rehab or in hospice is ending: call the QIO named on your paper before you leave, or by noon the day after you get the notice. Acentra Health or Commence Health runs it, depending on your state. The number for your state is on your paper. If you have no paper, this page has a map showing which company covers your state
Before you call: what to have ready
Have ready
- the Important Message from Medicare, or the Notice of Medicare Non-Coverage, with the QIO's name and toll-free number on it
- a way to be reached: 42 CFR 405.1206 says that when the QIO asks, you or your representative must be available to discuss the case
They may ask
- why you think coverage should continue
They can
- look at your medical records and the information the hospital or provider gave it, and decide whether your covered services should continue
- let you ask for copies of the materials that were sent to it: Medicare.gov says you can
- protect you from the hospital bill while it decides: if you ask in time, you do not pay for the extra days up to noon the day after it decides, apart from your usual coinsurance or deductible
They cannot
- promise to stop a hospital discharge: one of the two Medicare reviewers reports that in most hospital-discharge appeals it agrees with the hospital, and that appeals about care ending in a nursing facility, at home, in hospice or in outpatient rehab go the patient's way about half the time. So ask, and at the same time plan for the care ending
- be reached on one national number: the number for your state is on your notice, and the CMS region map lists them
for questions about your Medicare coverage or the steps in your notice, 24 hours a day (except some federal holidays). A fast appeal is not made here: it goes to the QIO named on your paper
Call 1-800-633-4227 · 24 hours a day, 7 days a week (except some federal holidays)
Before you call: what to have ready
Have ready
- your Medicare Number, and the notice or Medicare Summary Notice (MSN) about the decision, with its date
They can
- answer billing questions and questions about your claims and expenses, by phone or in your secure Medicare account
- give you more information about the appeal steps and what each level needs
- take calls from TTY users on 1-877-486-2048
They cannot
- talk to someone else about your case unless you have filled out an Authorization to Disclose Personal Health Information
- answer for a Medicare Advantage or drug plan's appeal: your plan's papers say how to appeal
State Health Insurance Assistance Program (SHIP)
free one-on-one Medicare counseling, including help with an appeal: pick your state to find your local office and its phone number
Before you call: what to have ready
Have ready
- your Medicare Number and any Medicare Summary Notice or plan letter about the decision
They can
- give you free one-on-one counseling about Medicare
- help you file a Medicare appeal (Medicare.gov names SHIP as a place to get this help)
They cannot
- give counseling on the national number: it puts you in touch with your local SHIP, as does picking your state on shiphelp.org
- pay your bill
Long-Term Care Ombudsman (your state's office)
if a nursing home or a similar home says you must leave, or will not take you back after a hospital stay: call your state's ombudsman the same day. A nursing home's written notice must give its name and number, and the state finder is linked from this page
Legal Services Corporation — Find Legal Aid
if a nursing home is moving you out, or you need help after the QIO says no: find free legal aid for civil problems. It is usually for people on low incomes. When you call, say the notice has a date on it
lsc.gov · Website, any time
Before you call: what to have ready
Have ready
- an address or a city: the finder uses it to show the legal aid organization that covers your area
They can
- show you the LSC-funded legal aid organization for your area, with its phone number and website, for a civil legal problem
- point you to LawHelp.org for information about your legal questions and free legal forms
They cannot
- take every case: LSC's own study says the legal aid groups it funds turn away about half of the requests they get, for lack of resources. If the first office cannot take your case, ask it who else can help
- give you legal advice itself: LSC pays for legal aid organizations, and you contact the one for your area
to find local help for an older person coming home, such as meals, rides or home care: call 1-800-677-1116 on weekdays, or search your area on the site
Call 1-800-677-1116 · Phone line Mon–Fri; website any time
Before you call: what to have ready
Have ready
- the place where the help is needed: the site asks you to enter a location
They can
- connect you to services for older adults and their families in your community
- answer by phone or text, online chat, or email, from trained staff
if there is no food or money for the first days at home: say what has happened and ask what local help is open
Call 211 · 24/7 in most areas
Before you call: what to have ready
Have ready
- a few facts about your current living situation
- any income you have
- the children or other dependents who live with you
They may ask
- about your current living situation
- about any income you have
- about any children or other dependents who live with you
They can
- connect you to local help with rent, mortgage, utilities, food and health care
- talk to you by phone; some local 211s also offer text and web chat, so check yours
- use 180 languages on request
- give you other ideas if you do not qualify for one program: you can call again
They cannot
- give you money themselves: 211 is the number for information and referrals to services
- help in a life-threatening emergency: call 911 first if you or someone you love is in one or may be a danger to someone else
In the United Kingdom
England: if a symptom starts at home and it is not a life-threatening emergency, where to get help. For a life-threatening emergency call 999
Call 111 · 24 hours a day
Before you call: what to have ready
They can
- direct you to the best place to get help: an emergency 999 or A&E, an urgent treatment centre, an out-of-hours GP, a nurse callback, a pharmacist, or care at home
- take your questions online, in the NHS App or by phone; call if the person is under 5
- take text relay calls on 18001 111 and BSL video through signvideo.co.uk/nhs111, and give an interpreter on a call
They cannot
- issue fit notes or make or cancel appointments for you in other parts of the NHS: contact your GP for those
- let you ask for a nurse callback: one is offered depending on your symptoms. If you miss all 3 tries, you cannot call the nurse back and must start again with 111 online or a new call
If you are offered a nurse callback, the wait depends on your symptoms, and the service is usually busier at weekends and on bank holidays. You do not need to call again while you wait unless your symptoms change or get worse.
the same help in Scotland. For a life or limb threatening emergency call 999
Call 111 · 24 hours a day, 7 days a week
Before you call: what to have ready
Have ready
- if you are phoning for someone else, be with them at the time of the call
They may ask
- who you are
- where you are phoning from
- why you are phoning
They can
- assess you and refer you to your local NHS services, which may be a phone or video consultation with a clinician, or an appointment at A&E or a Minor Injuries Unit
- offer a call back at weekends and public holidays, instead of waiting on hold
They cannot
- arrange appointments at your GP or manage appointments in your local area: your local health board contacts you
- deal with a life or limb threatening emergency: phone 999 or go to A&E
Busiest 6pm to 9pm on weekdays and 9am to midday on Saturdays and Sundays. If you miss a callback, a nurse tries up to 3 times; after that you phone 111 again.
the same help in Wales. In a medical emergency call 999
Call 111 · 24 hours a day
Before you call: what to have ready
They can
- help you find services near you by postcode or town, including GPs, pharmacies, and hospitals with emergency departments and minor injuries units
- let you check your symptoms online
- give advice on what to do out of hours, and point you to a pharmacy for a common ailment or medication
GP out of hours service (Northern Ireland)
the same help in Northern Ireland, which has no 111: in the day call your GP; when the surgery is closed, phone the out-of-hours service for your area. In an emergency call 999
nidirect.gov.uk · 6.00pm on weekdays until your GP surgery opens the next morning; 24 hours on Saturday, Sunday and public holidays
Before you call: what to have ready
They can
- assess you by phone: the doctor or nurse will give you advice, decide if you need to see a doctor, or refer you to another service
- take textphone calls: the page gives 18001 followed by the area number
They cannot
- help with repeat prescriptions, dental problems or minor ailments a pharmacist can treat
- replace 999: if your condition is life-threatening, phone 999 immediately and ask for an ambulance
- answer in the daytime on weekdays: the service runs from 6.00 pm on weekdays until your GP surgery opens, and 24 hours on Saturday, Sunday and public holidays
if there is no food in the house: find your nearest food bank. You need a food voucher first, from a local organisation; the page says how to get one
Before you call: what to have ready
Have ready
- how many adults and children the parcel is for, and the ages of any children: volunteers check these from your voucher
- any dietary requirements: say so when you get your voucher so the food bank can prepare
They may ask
- the community organisation that gives you a voucher asks about your individual needs, so it can help you find the right support
They can
- help you find your nearest food bank
- give an emergency food parcel with at least three days of meals once you have a food voucher from a local community organisation
- sometimes provide pet food and essentials such as toiletries and period products, where they can
- sometimes offer extra support, such as debt advice or a trained Citizens Advice adviser
- sometimes deliver food parcels: ask when you get your voucher, or contact the food bank
They cannot
- give you a parcel without a food voucher: you need a referral first
- usually give you a voucher online: you will usually need to contact a community organisation by phone or in person, and in some cases the food bank directly
Find your local council (GOV.UK)
England, Wales and Scotland: find your council, then ask its adult social services (social work in Scotland) for a care needs assessment (in England the NHS says it is free), and a carer's assessment if you look after the person
gov.uk · Website, any time
Before you call: what to have ready
Have ready
- who lives with you, including children and anyone ill
- about a rented home: the dates you told your landlord, and copies of your messages
- about a rented home: photos or video of the problem
- for a carer's assessment in England: your NHS number if you have one, your GP's name, address and phone number, and the name, address, date of birth and NHS number (if you have it) of the person you care for
- for council tax: the account number and the date of your newest letter
They can
- for a rented home: inspect a privately rented or housing association home and take action against the landlord
- for adult social care: take a request for a care needs assessment, or a carer's assessment; in England the NHS says you can call or do it online, and the assessment is free
- for council tax: take a request for a payment plan, including spreading the bill over more payments, and for a check on Council Tax Reduction and discounts
They cannot
- act against itself if the council is your landlord: complain to it as your landlord
- in Northern Ireland: do care assessments (your Health and Social Care Trust does), give homelessness help (the Housing Executive does), or take rates (Land & Property Services does)
Health and Social Care Trusts (Northern Ireland)
Northern Ireland: pick your local Health and Social Care Trust, then ask its social services for an assessment of need, and a carer's assessment if you look after the person. The same Trust takes complaints
if you look after someone who is coming home: free information and signposting on carers' assessments and how to complain, by phone on weekdays or by email
Call 0808 808 7777 · Monday to Friday, 9am to 6pm
Before you call: what to have ready
They can
- give information and signposting by phone, and more detailed guidance by email (advice@carersuk.org)
- answer questions about carers' assessments, benefits and financial support, services for carers, and how to complain and challenge decisions
- point you to your local carers' organisation, which has details on carers' assessments, emergency card schemes and respite
They cannot
- update your Carer's Allowance claim or check whether it has been paid: Carers UK is not part of the DWP
- always give the same specialist help by phone as by email: if it cannot help by phone, it will tell you other ways to get that support
England, for an older person or someone looking after one: free advice every day, including its guide on being discharged from hospital. Age UK has separate partners in Scotland, Wales and Northern Ireland
Call 0800 678 1602 · 8am to 7pm, 365 days a year
Before you call: what to have ready
They can
- give free information and advice by phone, 8am to 7pm, every day of the year
- point you to a specialist adviser at a local Age UK
- arrange free interpreted calls through its partner Wordskii
They cannot
- help in a medical emergency or with urgent physical or mental health needs: call 999 or NHS 111
Llais (Wales): free help to make an NHS or social care complaint
Wales: free, independent help to make a complaint about the NHS or social care, including on someone else's behalf
Patient and Client Council (Northern Ireland)
Northern Ireland: free support and advice if you want to complain about health or social care, on weekdays
Call 0800 917 0222 · Monday to Friday, 9am to 4pm, excluding bank holidays
Public Service Ombudsman (NHS in England and UK government services)
England: the last stage for an NHS complaint, after the hospital has replied. Complain to the hospital first; the time limit is on the England complaint clock above
Call 0345 015 4033 · Monday to Thursday, 9am to 4pm; Friday, 8.30am to 12pm; closed on bank holidays
Local Government and Social Care Ombudsman (England)
England: the last stage for a complaint about the council's care assessment, a care home or a home care agency, after you have complained to them. Call on weekday mornings (Wednesday afternoon), or complain online
Call 0300 061 0614 · Monday, Tuesday, Thursday and Friday, 10am to 1pm; Wednesday, 1pm to 4pm
Public Services Ombudsman for Wales
Wales: the last stage for an NHS complaint, after the health board has replied. Complain to the health board first, then contact the Ombudsman soon after its reply: call on weekdays or use the online form
Call 0300 790 0203 · Monday to Friday, 10am to 4pm
Patient Advice and Support Service (PASS), Scotland
Scotland: free help to complain about NHS care, including writing letters, on weekdays. It cannot advise about social care: for that, ask the council
Call 0800 917 2127 · Monday to Friday, 9am to 5pm
Scottish Public Services Ombudsman (SPSO)
Scotland: the last stage for an NHS complaint, after the NHS board has replied. Complain to the board first. Its site says there can be a wait before a complaint is taken up
Call 0800 377 7330 · Phone: Tuesday 1pm to 5pm, Wednesday and Friday 9am to 1pm. Closed Monday and Thursday.
Northern Ireland Public Services Ombudsman (NIPSO)
Northern Ireland: the last stage for a health and social care complaint, after the Trust's process has ended. Complain to the Trust first, and keep the letter that says its process has ended: the time limit starts from it
Say it this way
Change anything to your own words.
I am worried that going home [today] is not safe because [reason]. Could you tell me the plan: how I get home, who visits, what help and medicines are arranged, and who I call if something goes wrong? Please write it down. Could I talk to the doctor and the social worker before we agree a time?
I have Medicare [or: I am calling for [name], who has Medicare]. The hospital says the discharge is on [date], and we disagree. We are asking for a fast appeal. The hospital is [hospital], and the Important Message from Medicare is dated [date]. What do you need from us, and when will we hear?
[Name] is in [hospital] and will need help at home when they leave. Please arrange a care needs assessment. I look after them, so please arrange a carer's assessment for me too. Who will contact us, and when? Please give me your name and a phone number.
Before I sign, please send me the contract and the price list in writing. Please tell me who is responsible for paying, what is included, what happens to the fee if [name] goes back into hospital, and how notice works. I will read it and ask for advice before I decide.
Not for you if…
This guide is for someone leaving hospital, or being moved between care settings, and for the person looking after them. It does not give medical advice: ask the ward or your doctor about treatment and about what to watch for at home. In the UK, the official pages for all four nations describe no appeal against a discharge date. England's guidance says you have no right to stay in a hospital bed you no longer need. The same guidance says no one should be sent home until it is safe: see the first step under Today. Scotland's site says you cannot stay in hospital while you wait for a place; it says to speak to the doctor in charge if you disagree. What you can ask for is on this page. The US fast appeal is only for people with Medicare. If you have Medicaid or private insurance, your notice or plan papers give your dates. If you do not have Medicare and the hospital's plan is not safe, ask for the hospital's patient advocate, or ask how to make a formal complaint (its grievance process): federal rules say it must tell you whom to contact. In England, if you were sectioned (held for treatment under the Mental Health Act), the NHS says aftercare should be free and your needs assessed before you leave: ask the ward, and see the NHS page on mental health aftercare. If the hospital bill is the problem, the medical bill guide fits better. If someone has died, the guide for when someone has died fits better. You need a lawyer or adviser, not just this page, if the QIO says no and you want to keep challenging it, if a nursing home or care home says you must leave, if you are asked to sign something that makes you pay or guarantee fees, if you think the NHS should have paid for care you paid for, or if the person cannot decide for themselves and you need legal authority to act for them. Free help is under Who to call.
A different emergency? Account frozen or closed · Behind on mortgage · Benefits stopped · A car accident · Car repossessed or towed · Bullied at school · Suspended or excluded from school · Help at school · Council tax or rates · Debt collector or court papers · Deposit not returned · Eviction notice · Flood, fire or storm · Health cover ending · Unsafe home · Hurt at work · Paid a scammer · Lost my job · Lost wallet or phone · A medical bill · No money for food · Nowhere to sleep · Parking or traffic fine · Shutoff notice · Someone died · Stalking, harassment or shared pictures · Someone is missing · Identity theft · Stranded away from home · A tax bill · Told to leave home · Pay being taken · Wages not paid
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