Medicare and authorized advocates and representatives
May 1, 2020
During this time of the COVID-19 pandemic, it is a prudent idea to discuss the benefits of having a patient advocate and an authorized representative in the event that you are unable to represent yourself.
A patient advocate can be a health care professional or a trusted person, perhaps a relative or friend who can look out for your best interests when you are not well. The advocate’s overall mission is to guide a patient through the healthcare system. Their assistance can include providing support during the span of an illness including the testing, diagnosis, treatment phases as well as follow up medical care. They can provide numerous services including explaining medical findings, discussing treatment options, explaining and advocating your rights as a patient, supporting loved ones, handling patient complaints, and offering payment support such as working with insurance companies and offering other payment option information.
An advocate can assist you in understanding what your insurance covers and how it pays as well as understanding what amount, if any will be left over and be your responsibility. There are professional patient advocates, but many people choose to have someone known to them handle these responsibilities. Either way, choosing to have a patient advocate is an idea worth discussing with those close to you.
Original Medicare does not generally offer coverage for a patient advocate.
If you choose to have an advocate, it is important to arm them with the proper authorization to represent you effectively. You may choose to assign a power of attorney (POA) status to them. There are numerous types of POAs, but a Durable Power of Attorney acts as permission to allow this representative to handle things on your behalf should you become unable.
There are other ways of getting assistance to navigate the payment system. Providers’ billing offices can be very helpful in helping you understand the costs incurred. Medicare counselors (SHIP counselors in Alaska) can assist you in understanding your Medicare benefits and your Medicare Summary Notices. These are notices that are sent to Medicare beneficiaries every three months that explain the claims Medicare has processed on your behalf under Part A (hospital) or Part B (medical). This same information is available at your mymedicare.gov site.
If you choose to have an authorized representative assist you with your Medicare dealings, Medicare requires and provides their own form. This form must be completed and submitted to Medicare prior to discussing any medical information or coverage with an individual other than the Medicare beneficiary or a SHIP counselor. The form, CMS-10106, 1-800-Medicare Authorization to Disclosure Personal Health Information, in PDF format can be accessed at Medicare.gov under the “Forms, Help and Resources” tab on the home page. It is the first option under forms. It is available in English and Spanish. You can make choices about how much and what kind of information you will allow Medicare to disclose. Instructions on where to return your completed form are provided.
Be sure to complete the form carefully to assure that the permissions you are giving accurately reflect your desires. You will need to provide your Medicare Beneficiary Identification, which is on your red, white and blue Medicare card. Be sure to make a copy of the completed form prior to mailing so that you retain a record. It is a great idea to keep all of your Medicare documentation and communications in a safe, designated location such as a file or a binder.
You maintain the right to revoke or “take back” your authorization at any time, but it needs to be in writing. Upon receiving the change of authorization, Medicare will no longer recognize the representation of the person or organization that you had previously appointed, however, all actions that Medicare has taken based on your permission will stand. The decision to have an authorized representative does not affect your enrollment, eligibility or the amount Medicare pays for the health services you receive.
Knowing that you have these safeguards in place can ease your mind should you become unable to advocate for yourself.