Representatives and Advance Directives
Advance directives are documents that allow you to make decisions about healthcare and
treatment in case something happens to you or you are unable to communicate. They also
allow you to choose an individual, usually a family member or close friend, that you authorize
to make decisions on your behalf.
If you would like a friend or family member to make decisions for you related to your
Essence coverage and claims, Essence is required to obtain documentation which gives
that person the power to make those decisions. The most common forms of documentation
are the following:
DURABLE POWER OF ATTORNEY FOR HEALTH CARE: The Durable Power of Attorney for
Health Care (sometimes called a Health Care Surrogate) is a legal document that allows
you to appoint someone to make health care decisions for you either as soon as you sign
the document and/or when you are unable to make your own decisions because you are
incapacitated or unavailable. This document very specifically and purposefully calls
out the ability to make health care decisions. Some states will not permit a person to
make health care decisions on your behalf UNLESS it is specifically stated in the document.
GENERAL DURABLE POWER OF ATTORNEY: A General Durable Power of Attorney is
a written legal document that appoints someone to act as an agent to make decisions for you
and take actions on your behalf. The agent you designate can act on your behalf for the
different powers granted to them in the document (or if not specifically listed in the document,
as permitted under state law). Remember, some states do not permit health care decisions to be
made under a General Durable Power of Attorney unless those powers are specifically addressed
in the document. A General Durable Power of Attorney becomes effective when you sign it, and
continues to be in effect if you are not able to make decisions for yourself at a later date.
Medicare has specific requirements that must be met if you would like someone to file a
grievance, file an appeal, request an organization determination, or to deal with any of the
levels of the appeals process on your behalf. If you would like to designate someone to file
an appeal or take these actions, you will need to submit an Appointment of Representative Form
signed by both you and your representative. A representative can also file a request for you
if they provide documentation showing that the representative has legal authority to act on
your behalf. This documentation can include a General Durable Power of Attorney, a Durable
Power of Attorney for Health Care, or evidence that the person is a court appointed guardian.
Please visit the "Initial Organizational & Coverage Determinations, Exceptions, Appeals &
Grievances" tab for more information.
If you would like to permit Essence to disclose your medical and health care information to
another individual or organization, you should complete a HIPAA Authorization
Form and file a copy with Essence. Please note that
a HIPAA Authorization Form allows the person you designate to request and receive information
about you, but does not permit that individual to make decisions on your behalf.
There are other types advance directives that allow you to document your wishes so that the
physician or health care provider caring for you is informed on what kind of treatments you
would like to be administered if you are unable to communicate those decisions yourself. These
documents communicate your own decisions, but do not allow you to select someone to make
decisions on your behalf. Essence cannot rely upon these documents to permit decisions or
requests to be made for you about Essence coverage or claims.
LIVING WILL: A living will is a legal document that describes the
kind of medical treatments or life-sustaining treatments you would want if you were
unable to speak for yourself and you have a terminal condition. Living wills provide
the attending physician with directions on how you want to be cared for. Living wills
do not allow you to select someone to make decisions for you.
DO NOT RESUSCITATE: A do not resuscitate (DNR) order is a document
prepared by your doctor instructing healthcare providers not to attempt CPR in case
of a cardiac or respiratory arrest. If you have questions or want more information
about a DNR order, you should speak to your doctor.
Following is a list of the available on-line advance directive resources for residents of
Missouri and Illinois. These resources provide helpful information about the types of directives
outlined here, but should not be considered a substitute for communication with your family,
providers, and professionals who assist in drafting such documents. A key to successful advance
planning is communication with both your physician and your family members about your wishes.
Essence provides these resources to its members for informational purposes and does not endorse any particular document or approach. Essence bears
no responsibility for the accuracy, legality or content of the external sites or that of subsequent links. Please seek advice from an attorney if
you have any questions or need advice on what form is right for you.