How to Appoint a Personal Representative for Your Aetna Medicare Plan

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 10/21/2018

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Whether you have a Medicare Advantage plan or a Medicare Prescription Drug Plan from Aetna, or from any insurance company that contracts with Medicare, you have certain rights guaranteed to everyone who participates in the Medicare program. For example, you have the right to do the following (this is not a complete list):

  • File an appeal for any decision made about your care.
  • Have health-care services explained to you in a language you understand, and in a culturally-sensitive way.
  • Make a formal complaint—against a provider, the private company contracted with Medicare to provide your benefits, or any other person or entity involved in your care. Generally, you file a complaint if you disapprove of the quality of care you’re getting. If you disagree with coverage decisions, you’d file an appeal.
  • Request a decision about coverage for a particular service or treatment.
  • Appoint someone to represent you, or act on your behalf in any of the above actions.
  • Receive emergency care without unnecessary delay or travel.

Who can act as my personal representative under my Aetna Medicare plan?

Although your health-care provider may act on your behalf in certain situations, such as requesting a coverage decision, you can appoint someone as your personal representative to file complaints and appeals. Here are some examples of people you may wish to authorize to act on your behalf.

  • Your spouse or other family member
  • A trusted friend
  • Your doctor, pharmacist, or other health-care provider
  • A lawyer or professional advocate

How do I appoint a personal representative?

The easiest way to appoint a personal representative is to fill out a form that the Centers for Medicare & Medicaid (CMS) makes available for this purpose: the CMS Appointment of Representative form. Make sure you fill out several copies, because your representative will need to send Aetna this form each time he or she makes an inquiry on your behalf.

If you prefer, you can write a letter instead, which Aetna Medicare plans will accept in place of the form as long as both you and your personal representative sign and date the form, and it includes:

  • Your Aetna Medicarehealth-care ID number (HCIN) or Medicare number
  • Contact information: the names, addresses, and telephone numbers of both you and your representative
  • A statement giving your representative permission to act on your behalf and authorizing Aetna Medicareto discuss your personal information with him or her
  • A statement that your representative has agreed to act on your behalf

Send your letter or forms to Aetna Medicare Plans Customer Service at this address:

Aetna Inc.
P.O. Box 14088
Lexington, KY 40512
USA

What happens after I appoint a personal representative?

Your authorization form expires after one year from the date that you and your representative sign it. If you want your representative to continue to act on your behalf, you will need to fill out a new form. During the time the authorization is in force, Aetna will contact your representative instead of you with any requests for information and decisions about the outcome of your complaints and appeals.

Your representative can act on your behalf for all your appeals, complaints, or coverage requests — including hospital, medical, and prescription drugs — or you can limit his or her authority to matters concerning just medical benefits or just pharmacy benefits.

If you have already appointed someone with legal authorization to act on your behalf – for example, if someone has durable power of attorney to make health-care decisions for you – that person doesn’t need to complete the CMS Appointment of Representative form to act on your behalf with your Aetna Medicare plans.

If you’d like to know more about Aetna and its Medicare plans:

*Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, free language assistance services are available. Visit our website at www.aetnamedicare.com or call the phone number listed in this material.
ESPAÑOL (SPANISH): ATENCIÓN: Si usted habla español, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web en www.aetnamedicare.com o llame al número de teléfono que se indica en este material.

繁體中文 (CHINESE): 請注意:如果您說中文,您可以獲得免費的語言協助服務。請造訪我們的網站www.aetnamedicare.com 或致電本材料中所列的電話號碼。

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