How to appoint a representative

For Medicare Part C appeals, Humana can review appeal requests from a member, the member’s representative, or, in many instances, the member’s doctor. For Medicare Part D appeals, Humana can review appeal requests from a member, the member’s representative, or the member’s doctor or a non-physician prescriber.

For grievances of any type, Humana can review requests only from the member or the member’s representative.

A member’s representative is someone that a member designates on an Appointment of Representative form, or a legal representative that has been appointed by a court or under state law.

If you are a Humana member without a legal representative, you can give permission for another person to act as your representative for requesting an appeal or grievance on your behalf by completing and sending the Appointment of Representative Form. Both you and your representative must sign the form for it to be valid.

If you are a Humana member who has a legal representative, the representative can request a grievance or appeal on your behalf by sending documentation of the legal representation or the Appointment of Representative Form.

Download the Appointment of Representative Form below. This form can be used for appeals and grievances for both Part C and Part D plans.

Appointment of Representative Form – English

Appointment of Representative Form – Spanish

You also can get the Appointment of Representative Form on CMS' website.

Refer to Chapter 9 of your Evidence of Coverage (EOC) for more information about the grievance and appeals processes.

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