Getting permission to talk with your family member's insurance plan

Health insurance plans have to follow rules about privacy. You might need permission to talk about someone else's plan.

If you family member's health coverage is NOT through your policy you must confirm that you have the right to talk with the insurance company about them.

This is important if you need to:

  • File a claim.

  • See if the plan covers certain services or drugs

  • Appeal if they deny coverage for something

If someone else (like your spouse or an ex-spouse) owns the policy, here's what you can do:

  1. Call the insurance company. Use the 1-800 number on your family member’s insurance card. Ask if you’re allowed to speak to them about the plan.

  2. If they say that you're not authorized, tell the policy owner to call and ask them to give you permission. The policy owner may need to fill out a form.

  3. Submit documents to the insurance company showing that you have the legal right to conduct affairs on behalf of your family member. These could be things like a custody agreement, guardianship, general power of attorney, or a health proxy.

If you have MassHealth, click the box below for specific instructions: 

If you need permission to work with MassHealth on your family member's behalf, you can fill out a form asking to be their Authorized Representative.

This will allow you to talk to MassHealth about your family member's application and benefits.

Here's what you can do:

  1. Make sure you don't already have authorization (permission). If you're not sure, call the MassHealth Customer Service Center :1-800-841-2900 (TTY: 1-800-497-4648)

  2. If you do need authorization, click the link at the bottom of the page to download the Authorized Representative form. Follow the instructions and submit the form.

Note: Visit the Exceptional Lives Guardianship Guide to learn more about options for helping an adult family member with healthcare decision-making.

 

Source: MassHealth

 

See the Exceptional Lives Guardianship Guide to learn more about healthcare decision-making for adult family members.

 

Source: MassHealth

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