How to Appoint a Personal Representative for Your UnitedHealthcare Medicare Plan
This article was updated on: 10/21/2018
There may be times when you or a loved one needs help managing Medicare benefits under a UnitedHealthcare Medicare health plan or Medicare Part D Prescription Drug Plan. Occasionally, you may want to request or appeal a coverage decision, or even file a grievance or complaint against someone involved in your care.
Privacy laws, however, require that anyone you want to represent you in these situations be officially authorized by you to access your personal information and act on your behalf. Here’s what you need to know about personal representatives and how to appoint one for your UnitedHealthcare (UHC) Medicare health plan or Medicare Part D coverage.
Who can be a personal representative for my UnitedHealthcare Medicare plan?
This is a personal decision; you may choose anyone you trust to respect your wishes and act in good faith on your behalf. Some people choose a spouse, sibling, child, or other family member, while others prefer a friend, social worker, counselor, or member of the clergy. Some people choose a lawyer or legal advocate.
Keep in mind, the person you select may have access to portions of your health record and other personal data, so you may want to choose someone you feel confident will protect your privacy.
To appoint a personal representative for your UnitedHealthcare plan, you can download, complete, and return . If you prefer to write a letter, make sure you include all the . Both you and your representative must sign and date the form or letter.
In some cases, you may want to share protected health information with another person or agency without granting them authorization to represent you with your UnitedHealthcare Medicare Advantage or other plan. You may authorize disclosure of your health record by downloading, completing, and returning to the address required by your plan.
The decision to share health information or authorize a personal representative is entirely voluntary, and you may revoke your permission at any point by writing to your plan. However, be aware that your UHC plan may have already disclosed some of your health information before you decided to revoke the authorization.
When do I need to appoint a personal representative for my UnitedHealthcare Medicare plan?
In some cases, your doctor or other prescriber may initiate certain actions on your behalf with your UnitedHealthcare Medicare health plan or Medicare Part D Prescription Drug Plan without official authorization as a personal representative. For example:
- Your doctor or other provider can request a coverage determination about a procedure or other aspect of your care under your plan.
- Your doctor or other prescriber can request a coverage decision about a prescription drug and even request an exception to a formulary rule under your plan.
However, there are some actions that only you or your authorized representative can initiate:
- Escalating an appeal over a coverage decision under your plan
- Filing a grievance or complaint against someone involved in your care
What happens after I appoint a personal representative for UnitedHealthcare Medicare plans?
- When you appoint a personal representative to act on your behalf, your UnitedHealthcare Medicare plan will correspond with your appointed representative, not with you, about the specific request (such as an appeal) that you appointed him or her for.
- If you’d like, you can restrict your representative’s authority to only your Medicare prescription drug coverage, or only your Medicare health coverage. If you have a UHC Medicare Advantage Prescription Drug plan, ask the plan for guidance about how to limit the representative’s appointment.
- The appointment of a representative expires one year after the date that you and your representative sign it. If you want your representative to continue to act in your stead, you’ll need to fill out a new form
- For every new appeal, you or your representative needs to send a copy of the authorization to your UHC Medicare plan.
Do you have questions about appointing a personal representative, or downloading and completing your form? To learn more about UnitedHealthcare, visit the UHC Medicare profile page. If you’d like to compare Medicare plans, use the Find Plans button on this page.
If you’d like more information about how the appeals process works, you can also call 1-800-MEDICARE; representatives are available 24 hours a day, 7 days a week.