How to Appeal an Unsafe Hospital Discharge in Delaware

If you believe a Delaware hospital is discharging your parent too early, you can file a formal appeal that freezes the discharge and forces an independent physician review — at no cost to you. The appeal goes through Commence Health, Delaware's federally contracted Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), at 888-396-4646. You must file before midnight of the day after the hospital delivers the discharge notice. Here's exactly how the process works.

The Discharge Notice That Starts the Clock

When a Delaware hospital — ChristianaCare, Bayhealth, Beebe Healthcare, or any Medicare-participating facility — decides to discharge a Medicare patient, they must deliver two documents:

The Important Message from Medicare (IM) is given on admission and again at least two hours before discharge. This form tells you that you have the right to an expedited review if you disagree with the discharge decision.

The Detailed Notice of Discharge (DND) explains the specific clinical reasons the hospital believes the patient no longer needs acute inpatient care. This is the document you're actually appealing against.

The moment the DND is delivered, your appeal clock starts. You have until midnight of the next calendar day to contact Commence Health.

Step-by-Step Appeal Process

Step 1: Call Commence Health Before the Deadline

Call 888-396-4646 and tell them you want to file an expedited review of a hospital discharge. They will ask for:

• The patient's name and Medicare number
• The hospital name and unit
• Your relationship to the patient (you don't need Power of Attorney to file an appeal — any interested party can)
• Why you believe the discharge is premature

You can file by phone from anywhere — you don't need to be physically present in Delaware.

Step 2: The Automatic Stay Takes Effect

Once you file, two things happen immediately:

1. The discharge is paused. The hospital cannot force your parent to leave while the appeal is pending.
2. The billing clock stops. Medicare continues to cover the hospital stay during the review period — your parent won't be charged for the additional days.

This is why timing matters. If you miss the midnight deadline, the hospital can proceed with the discharge, and you lose both the stay and the billing protection.

Step 3: Commence Health Conducts the Review

A physician reviewer at Commence Health — someone who didn't participate in the original discharge decision — reviews the medical records and decides whether the discharge is appropriate. The review typically takes 24–72 hours.

During this time, the hospital may push back. Discharge planners and case managers sometimes pressure families by implying the appeal will cost money or delay care. It won't — the review is free, and Medicare coverage continues.

Step 4: You Get the Decision

If Commence Health agrees the discharge is premature, the hospital must continue the inpatient stay. If they agree with the hospital, Medicare coverage ends at noon the day after the decision is delivered.

Even if you lose the appeal, you've gained critical time — often 2–3 days — to arrange post-acute care, evaluate facilities, and coordinate with family.

When an Appeal Makes Sense

Not every discharge warrants an appeal. File when:

• Your parent's condition hasn't stabilized — they still need IV medications, wound care, monitoring, or therapy at a hospital level
• The discharge plan is incomplete — no home health order, no follow-up appointments scheduled, no medication reconciliation done
• Your parent can't safely perform basic daily activities and the hospital hasn't arranged skilled nursing or rehab
• The hospital is discharging to a setting that can't provide the level of care needed
• You suspect observation status was incorrectly assigned — check the Medicare Outpatient Observation Notice (MOON)

Don't file just to buy time. The QIO physician reviews medical necessity, not convenience. But if you have a legitimate clinical concern, filing protects your parent and gives you leverage to demand a complete discharge plan.

The Observation Status Wrinkle

Before filing, verify your parent's admission status. If they were classified as "observation" rather than "inpatient," the standard QIO discharge appeal doesn't apply in the same way — observation patients have a different appeal pathway.

More critically, observation days don't count toward the three-midnight rule for Medicare Part A skilled nursing coverage. If your parent needs rehab at a skilled nursing facility after discharge, observation status can mean the entire SNF stay comes out of pocket. Ask the attending physician about converting to inpatient status before discharge, and file a prospective appeal using the Medicare Change of Status Notice (MCSN) if applicable.

What Happens After the Appeal

Win or lose, the appeal gives you information and time. Use both:

• If you won: Work with the care team on a discharge plan that addresses the gaps you identified. This is your opportunity to push for a skilled nursing referral, home health order, or additional therapy.
• If you lost: You have 2–3 days before coverage ends. Use that time to contact the Delaware ADRC (1-800-223-9074) to begin screening for DSHP-Plus Medicaid if your parent needs long-term services. Start evaluating post-acute options immediately.

The Hospital-to-Home in Delaware toolkit includes the complete appeal process with word-for-word scripts, the Commence Health contact protocol, observation status verification steps, and post-appeal planning checklists — organized for families in the middle of a crisis, not reading a policy manual.

Frequently Asked Questions

Do I need a lawyer to appeal a hospital discharge in Delaware?

No. The QIO appeal through Commence Health is a free, informal process. You call, state your concern, and a physician reviewer examines the medical record. An attorney isn't needed for this step. If you want to pursue further appeals beyond the QIO decision, the next level is an Administrative Law Judge hearing — which is rare and may benefit from legal representation.

Can the hospital retaliate if I file an appeal?

Hospitals are prohibited from retaliating against patients or families who file QIO appeals. Medicare's Conditions of Participation protect this right. If you experience pressure or threats, document them and report to the Delaware Long-Term Care Ombudsman (1-855-773-1002) or the Joint Commission.

What if I miss the midnight deadline?

If you miss the expedited appeal deadline, you can still request a standard (non-expedited) review, but you lose the automatic stay — the hospital can proceed with the discharge while the review is pending. This is why calling Commence Health immediately after receiving the discharge notice is critical.

Can a family member file the appeal, or does it have to be the patient?

Any interested party can file — the patient, a family member, a legal representative, or a friend acting on the patient's behalf. You don't need Power of Attorney. You can file from any state by phone.

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