If you are unwilling or unable to file a Medicare appeal on your own, you have several options. One of them is to appoint a representative. This can be anyone from a family member to a doctor or attorney to a family friend. Your representative, once appointed, can act on your behalf during the Medicare appeals process. This means they will be the ones filing your appeal, asking for and presenting evidence to substantiate your appeal, and receiving updates and notices related to your appeal.
Before expending the effort to choose a representative, you should understand when your appeals can be handled without one. For example, a Durable Power of Attorney agreement can work in place of a representative’s appointment. Those with Power of Attorney already have the rights to your medical information and the ability to make medical decisions on your behalf, so you do not need to complete extra paperwork to have them handle your Medicare appeals. Also, if your medical provider is the one petitioning Medicare for coverage, you can transfer your appeal rights to them via a “Transfer of Appeal Rights” form.
More than one person can be appointed as a representative. However, you will have to appoint each person separately. Only individuals can be appointed as representatives, so you cannot name organizations, groups, or firms as representatives.
Your representative should be someone you trust. Understand that whoever you appoint as a representative has the right to access personal medical information related to your appeal. However, not all your information is at their disposal. Unless you fill out an “Authorization to Share Personal Information” form, a representative cannot access medical information that does not have bearing on your appeal.
Two ways to appoint a representative
Once you have chosen a suitable person as a representative, there are two ways to appoint them. The first and simplest way is to fill out an “Appointment of Representative” form found on Medicare.gov. This form requires the contact information and signatures of both you and your prospective representative. The representative’s relationship to you must also be detailed. If your representative chooses not to charge you for their service, they will need to complete an additional section verifying this.
You can also appoint a representative through written request. This will have to be submitted alongside your first appeal, and include all the same information as the “Appointment of Representative” form. This includes:
- Your Medicare number (at the top of the page)
- Your address and contact information
- Your representative’s address and contact information
- The relationship of your representative to you (sibling, doctor) or their professional status
- An authorization to release relevant health information to your representative
- An explanation of why you’re being represented and the limits of the representation
- The signatures of both you and your representative
- The dates you and your representative signed the request
Note that this method of obtaining a representative can be unwieldy. If you have further questions about how to appoint a representative or what Medicare representatives do, don’t hesitate to call 1-800-MEDICARE for help.