How to Appoint a Personal Representative for Your WellCare Medicare Plan

Last Updated : 10/21/20184 min read

You have rights about the care and treatment you receive under the Medicare program. If you are enrolled in a WellCare Medicare Advantage plan or a stand-alone WellCare Medicare Part D Prescription Drug Plan, your rights include (but aren’t limited to):

  • Requesting a review of a coverage decision made by your plan
  • Requesting an exception to your plan’s formulary (list of approved prescription drugs)
  • Appealing any decision by WellCare or the Medicare program about your coverage
  • Filing a complaint or grievance about care you received

In some cases, your doctor or other prescriber can act on your behalf, but in other cases, only you or a person authorized by you can take action.

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Here’s what you need to know about when you need a personal representative and how to appoint one for your WellCare Medicare plan.

Who can be a personal representative for my WellCare Medicare plan?

You can authorize anyone you trust to respect your wishes and act on your behalf in situations involving your WellCare Medicare Advantage or WellCare Part D Prescription Drug plan. A personal representative can be (for example):

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

The decision to designate a personal representative is entirely voluntary and you can revoke your authorization at any time. If you have given someone health-care power of attorney according to the laws of your state, or the state has appointed a legal guardian to act on your behalf, you do not need to appoint that person as your personal representative. Your legal paperwork is sufficient; just be sure to send a copy to your WellCare Medicare health plan.

How do I appoint a personal representative for my WellCare Medicare plan?

You will need to either download and  from the Centers for Medicare & Medicaid Services (CMS), or write a letter describing your request in detail, and send it to the address shown on your WellCare Medicare plan brochure. Make sure you and your representative sign the form or letter. If you’re not sure where to mail your forms, you can call WellCare Customer Service at 1-866-530-9491 (TTY 1-877-247-6272) from Monday through Sunday, 8 a.m. to 8 p.m.

Be sure both you and your representative sign and date the form and make sure you each keep a copy for your records.

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When do I need to appoint a personal representative for my WellCare Medicare plan?

Again, the decision to designate someone to act on your behalf is up to you. You may want to ask for help, for example, if you’re not feeling well and you find the process of filing for an appeal to be a daunting task.

Your health-care provider or other prescriber can act on your behalf in the following cases without a form authorizing representation:

  • Request a coverage decision about a particular medical service or procedure you received through your WellCare Medicare Advantage plan
  • Request a coverage decision or an exception about a prescription medication
  • Request a coverage redetermination or reconsideration about a prescription medication

What happens after I appoint a personal representative for Aetna Medicare plans?

It’s important to note that your WellCare Medicare plan will communicate with your appointed representative, instead of you, concerning your appeal, coverage request, or other request for which you designated the representative to act on your behalf.

Your representative’s authorization is effective for one year from the date that you and your representative sign it. You’ll have to fill out a new form if you want your representative to continue to act on your behalf.

You can limit your representative’s authority to act for you, restricting him or her to handle your appeals, complaints, or coverage requests for medical benefits only, or prescription drug benefits only, if you prefer. If your request is about a WellCare Medicare Advantage plan that has prescription drug coverage, you may want to ask your plan for guidance if you want to limit your representative’s authority.

You or your representative will need to send a copy of the representative’s authorization for every new request, such as a coverage request or appeal.

Remember, if you have any questions about personal representatives and your WellCare Medicare health plan, you can always call WellCare Customer Service at the number above, or call the Medicare program directly at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Would you like to find out more about WellCare Medicare plans? You can:

  • Visit the WellCare Medicare page.
  • Click the Find Plans button on this page to take a look at WellCare Medicare plans in your vicinity.

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