How to Appoint a Personal Representative to Help File Your Appeals and Grievances
This article was updated on: 09/15/2018
As a Medicare beneficiary, you have the right to request an appeal of decisions made by your Medicare health plan, or to file a grievance about the care or treatment you received from a Humana provider or other provider while you are enrolled in a Medicare plan through Humana. The same is true no matter which Medicare-approved insurance company offers your Medicare health plan. If you would like someone to act on your behalf in these proceedings, you can appoint a personal representative under Medicare program rules. Here’s what you should know about using a personal representative to help with your appeals and grievances.
How do I appoint a personal representative?
IIf you would like someone to help you file an appeal or grievance with your Medicare health plan (whether through Humana or a different company), you must file a form to officially designate that person as your personal representative. Humana’s personal representative form is available on the company’s website, or you can download the form from the Centers for Medicare and Medicaid Services (CMS) website. The form must be signed both by you and the person you are appointing as your representative in order to be valid.
Return the form to the address in the Medicare health plan membership information booklet that Humana sent you when you enrolled. If you can’t find the address, or need help completing the form, you can call Humana Medicare Customer Service at 1-888-371-9538 (TTY Users: 711) from Monday through Friday, 8 a.m. – 8 p.m.
Who can be a personal representative?
The decision to appoint a personal representative is entirely voluntary and you can revoke your authorization at any time. You may choose anyone you trust to act on your behalf, such as:
- Your spouse
- Your child
- Another family member
- A personal friend
- A member of the clergy
- A counselor or social worker
- A lawyer or legal advocate
If someone appointed by the court is acting on your behalf, or is acting under the laws of your state, you do not need to file a form to authorize that person as your personal representative; however, you must send a copy of the legal authorization to your Humana Medicare plan.
When do I need to use the form for Medicare Advantage plan appeals?
You or your doctor can request reconsideration from Medicare health plans through Humana or another insurer, but you must file a form to authorize a personal representative if anyone other than you or your health-care provider initiates the request.
When do I need to use the form for Humana’s Medicare Part D Prescription Drug plan appeals?
You, your prescribing doctor, or other prescriber can request a redetermination from a Medicare Part D Prescription Drug Plans from Humana without a personal representative authorization form. If anyone else wants to act on your behalf, you will need to file the form with Humana.
When do I need to use the form for grievances?
If anyone other than you, the plan member, wants to file a grievance against Humana, you will need to file the form authorizing that person to act as your personal representative. If you’d like information about Humana’s Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans, just enter your zip code and click Find Plans on this page.
*Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. [Benefits, premiums and/or member cost-share] may change on January 1 of each year. The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.
**Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex.
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