Dear Pastor D.M.,

I am my wife’s caregiver and she has dementia. Recently, I called my insurance company to change her doctor and I was told by the agent that my wife had to authenticate her own information and account. I was frustrated as the agent asked my wife certain questions to verify her identity. My wife could not answer those questions, nor was she aware of what to say. I told the insurance agent that I was my wife’s caregiver.

Despite our many years of marriage, the doctor change on my wife’s account could not be made by me because I am not listed on her account to obtain information for her. Though we have been married for years, I am not seen as the substitute representative for my wife. Our marriage is legal, so why should I have to have legal paperwork in anything else?

My last call with the insurance company ended badly for me. Though the agent was kind and treated me and my wife with respect, I’m upset at the thought that, when it comes to my wife’s health, I cannot communicate with the insurance company without legal consent of some kind. As a last resort, I finally caved in and told the agent I would send the Power of Attorney paperwork to my wife’s insurance company so that I can make changes to the account despite my wife’s failing health.

How is this the case that, when my wife needs me to help her the most, I cannot because of an obstacle called paperwork? Is this normal? What should I do in this case?

why legal consent is important

Dear Concerned Reader,

Let me first say that I’m sorry about the battle with dementia your wife is having. I was a caregiver for a relative with dementia, so I realize how much of a challenge it can be. I certainly understand that you care about your wife and that you want to do everything in your power to fight for her best interest. I understand the love you have for your wife. I understand that you are her caregiver and that you see after her every day.

But with that said, however, you must understand that your legal consent of marriage with your wife is first, marital (not related to your wife’s insurance company). Your marriage license is valid for a lifetime, while you both live. Remember when you said “’til death do us part”? That little phrase there says that the commitment is lasting until death. Death alone, divorce excepted, is the only thing that breaks the marriage bond.

But even with the marital legal consent on file, your wife’s insurance company cannot use your marriage license as legal consent from your wife. The reason? There are a few, actually. First, the marriage license is for the purposes of marriage. Anyone can marry. However, one’s insurance policy is a separate matter. You may be the member’s spouse but if she dies, you cannot go to her insurance company and say “I’m gonna take over my wife’s benefits that she has not received.”

Even if you were on a group policy, you still wouldn’t be able to use your wife’s name to get authorizations, doctor’s visits, free gifts from the insurance company, and so on. You and your wife are separate people, though you both are married. Two separate people. You cannot have a union where “two become one” unless you have two distinct people. A person by two different names does not a union alone make.

The marriage license is not legal consent for the insurance company. Just as marriage requires legal consent from both parties, so must legal consent be for insurance companies. You cannot go to the insurance company and just say, “I’m her husband, let me change her doctor for her.” It’s not that easy. Rather, your wife must give verbal consent on the call (she must say, “I authorize my husband, x name, to do x, y, and z”) or she must give legal consent. She must sign a form saying that she agrees to you making changes on her account — that is, as long as she is able.

When she arrives at a point where she cannot speak for herself, then someone must speak for her. In that case, a Power of Attorney (called POA) or Designation of Healthcare Surrogate (DOH) can operate in such a capacity. In order to have such power with the member’s insurance company, you must submit that paperwork to the company so that you can be added to the member’s policy for purpose of obtaining information and making changes when you need to for her sake.

Marriage licenses do much in the world at large, but with individual policies, you will have to submit paperwork showing that your wife is incapable of speaking for herself. You may want to have it differently, but the insurance company, to avoid a lawsuit, must request that legal paperwork. They would much rather avoid a lawsuit and legal consequences than appease your preference in the matter.

not all consent types are created equal

Not all consent types are created equal. I mentioned above the issue with just relying on your marriage license with regard to becoming a consent party with the insurance company. Well, even if you become a consent party, you must understand that there are different types of consent — and not all consent types are created equal.

First, there is the CPHI. “CPHI” stands for “Consent for the release of Protected Health Information.” This is the basic form of consent for members of an insurance company. It says that someone you trust can call in and access information about your account whenever they like — as long as the consent forms are valid, that is. CPHI forms usually last no more than a year, so the member will have to consent every year for you to be a CPHI listed on the account.

If the member consented in 2022 but refuses to sign or agree again in 2023, then you cannot call in and obtain information regarding the member’s account in 2023. This consent gives you the right to call in and access information, but it doesn’t give you the right to, say, make a doctor change on the member’s account. So, even if you have the CPHI status, you will still need the member to be on the phone in order to get verbal consent. In the absence of legal consent (in this case, being the Power of Attorney or POA), verbal consent is necessary. Unfortunately, verbal consent lasts for only the duration of the call.

CPHIs do have the right to schedule a medical trip for a member, however, so they are not entirely powerless on that front. If a member has a medical trip, and their insurance company provides medical, non-emergent transportation (meaning, non-ambulance transportation), then yes, they can call and schedule a trip for a member without the member’s verbal consent. But, outside of verbal consent, that’s all CPHIs can do.

Then there are the designations above, such as Designation of Healthcare Surrogate. The DOH acts as a “surrogate” in the place of others who are likely far more related to the member. The Power of Attorney is the legal status of someone who is eligible to make all account changes for the member. So, if you decide to file that paperwork for someone you’re caregiving for, you would be able to make all changes to the member’s account without the need of verbal consent. In the event that the member dies, the only valid consent at death would be the Executor of the Estate, or the EoE.

These designations of authority are not designed to trap you in confusion and create a legal “alphabet soup,” but done for the sake of human dignity. All humans are persons under the law and before God; as such, they are to be treated with respect. And part of respecting humanity is to allow them to consent to whatever happens to them until they are no longer able to make sound decisions for themselves. In the event of dementia, should they lose that ability or their health declines to such a point, then someone else has to step in and make decisions for the welfare of the individual.

summing it all up

So, back to your original complaint: why is it that you have to file legal paperwork for your wife even though you’re married to her? Because she is a person under the law, and, though married to you, is still a separate individual with her separate right to consent. Just because she took your last name does not mean that she ceased being a separate individual with the right to consent.

According to Scripture, at marriage, the “two shall become one flesh,” but this does not mean that husband and wife morph together into one person. Both retain their individual rights and dignity, even in the face of marriage. This individual dignity is not to be used for sinful purposes, however, though some unfortunately choose to use it in such an unholy fashion.

Imagine if you were sick and unable to make sound life and health decisions. Think of one relative with whom you do not get along. If there were no legal consent required for changes on a member’s insurance account, anyone could come along and do anything to your account. You would not want that, would you? You would not be okay with someone having carte blanche freedom to just change your primary care doctor because they felt like it, or order your free gift card from the company (to use your free money for their own purposes).

No one wants to become a victim, but many of us rarely think about how important legal consent is until we’re at risk. And yet, if legal consent is good for protection, it’s also good when we feel we are safe and don’t need it. To disregard legal protections of any kind for others while inserting them only for ourselves is a bit of a double standard, don’t you think?

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