Saint Peter’s University Hospital is required to comply with state and federal laws, which state that hospital admissions are subject to review by the Quality Improvement Organization. This program represents the efforts of local physicians working together to ensure that your admission and continued stay in the hospital are medically necessary and that the quality of services provided to you meet professionally recognized standards of care.

Your health insurance company may also review the medical necessity for your hospitalization and authorize benefits based on your coverage.

If it is determined that your condition does not require inpatient acute hospital care, you may receive a written notice. If this occurs, your health insurance company will discontinue payment for hospital services on the effective date stated in the notice. Any hospital stay beyond the notification letter will not be covered by health insurance, and you will be financially responsible for any additional time in the hospital. Be assured that a decision regarding termination of benefits will be made only after a conference between your doctor and a physician advisor.

Early planning for discharge is beneficial for you and your family. It can help prevent a denial of health insurance coverage. Saint Peter’s Care Coordination staff, working with you, your family and your physician, can assist by arranging a plan of care to meet your needs after you leave the hospital.