Designation of Authorized Representative for Appeals

Nov 5th, 2024

A Designation of Authorized Representative is a formal document (form) that allows a third party, such as a friend, family member, attorney, or healthcare provider, to act on behalf of the patient/beneficiary in handling specific aspects of an insurance claim or appeal. When filing an insurance claim appeal, this designation gives the authorized representative permission to submit the appeal, communicate with the insurance company, gather information, and receive notifications on their behalf.

The following are some important things to note about this designation:

1. Authority:
   • The designated person/party can manage the appeal process, communicate with the insurance company, access claim-related information, and provide documentation needed for the appeal.
   • They act as your voice during the appeal, advocating for benefits or coverage that may have been denied.
2. Scope of Representation:
   • The designation may be limited to a specific claim or appeal or might extend to all dealings with the insurance provider, depending on the specifics listed on the form.
   • Some designations are temporary (e.g., just for the duration of the appeal process), while others may allow broader access.
3. How to Designate:
   • Most insurance companies have a specific form (typically called a "Designation of Authorized Representative" form) that needs to be completed and signed by both the policyholder and the designated representative.
   • The form will usually ask for details about the policyholder, the representative, and the scope of the authority being granted.
4. Privacy Considerations: It is CRITICAL to remember that healthcare and insurance information is protected by privacy laws (e.g., HIPAA). Completion of a Designation of Authorized Representative form does not necessarily mean that all privacy requirements are met. It is recommended that you review individual payer websites to see if additional information is required on any form used to ensure that privacy requirements are fully met.

This designation is useful when the policyholder needs help navigating the appeal process or prefers that someone else handle the interactions and paperwork involved in making an insurance claim appeal.

Resources

• CLICK HERE to download a sample “Designation of Authorized Representative” Form.
• CLICK HERE to link to helpful patient/beneficiary appeals information.