How to Appoint a Personal Representative for Your Coventry Medicare Plan

Last Updated : 09/10/20185 min read

Occasionally, you or a loved one may need help managing coverage and benefits under a Coventry Medicare Advantage plan or Coventry Medicare Part D Prescription Drug Plan. Fortunately, federal Medicare guidelines allow you to officially appoint a personal representative to act on your behalf – including filing an appeal about a coverage decision, for example.

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If you are enrolled in a Coventry Medicare health plan, here are the steps you should take.

Who can I appoint as my personal representative?

You’re free to choose anyone you’d like as your personal representative. You’ll probably want to choose someone you trust and who understands your wishes in regard to your health-care decisions. A personal representative might be:

  • Your spouse, child, sibling, or other family member
  • Your doctor or other health-care provider
  • A member of the clergy
  • A social worker or counselor
  • A lawyer or legal advocate
  • A close personal friend

Your personal representative will have access to your personal health information in many cases, so it’s important you feel comfortable discussing your care and treatment with the person you select.

You can restrict your personal representative’s authority to only your medical benefits or only your prescription drug benefits if you prefer to set such a limitation.

How do I appoint a personal representative?

Coventry maintains a library of all the forms you will need to manage your Coventry Medicare plan in a password-protected member portal to prevent unauthorized access and use. As a Coventry member, you can download the Medicare Member Designated Representative Form from the forms library.

If you’re not a Coventry member or you do not want to register for an account, you can also download the form from the government website.
Alternatively, you can write a letter to Coventry naming your representative and authorizing him or her to act on your behalf. Have the representative sign and date it, along with your own dated signature.

Once you and your representative have signed and dated the form or letter, return it to the address listed on your Coventry Medicare plan information booklet. If you have a Coventry Medicare Advantage plan and you can’t find the correct address, or have trouble accessing or completing the form, you can call Coventry Medicare Customer Service at 1-877-988-3589 (TTY users, call 711) from 8:00 a.m. – 8:00 p.m., local time, seven days a week, from October 1 – February 14 and from 8:00 a.m. – 8.00 p.m., Monday – Friday, from February 15 – September 30.

If you have a Coventry Medicare Part D Prescription Drug Plan, you can call 1-844-233-1938 (TTY:711), 24 hours a day, seven days a week, for assistance with the Medicare Member Designated Representative form.

When do I need to use a personal representative form?

You don’t need to complete a designated representative form if you or your health-care provider or other prescriber is requesting basic coverage decisions under your Coventry Medicare Advantage plan or Coventry Medicare Part D Prescription Drug Plan. You also don’t need to complete this form if you’d like to request an exception to a formulary decision — if your plan doesn’t cover a prescription medication your doctor has prescribed, your or your prescriber may request that .

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However, if you want someone other than your doctor or other prescriber to act on your behalf in these actions, you will need to officially designate a personal representative. In addition, only you or your personal representative may escalate a Medicare appeal or file a grievance or complaint against someone involved in your care under the Medicare program.

If you have authorized someone under the laws of your state to act with durable power of attorney, or if the state has appointed a legal representative to act on your behalf, you do not need to complete the designated representative form, but you will need to send copies of the legal authorization to your Coventry Medicare plan.

What happens after I appoint a personal representative?

You need to be aware that after you’ve sent your completed form and Coventry has processed it, Coventry will communicate with that person (instead of with you) about your coverage request, appeal, or complaint.

Your representative’s authorization to act on your behalf lasts for a year from the date you sign the form or letter. You typically need to repeat the process for every year that you want this representation.

For every new request, such as a coverage request or appeal, your representative must send Coventry a copy of the authorization.

  • Visit the Coventry page to learn more about Coventry Medicare coverage.
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