How to Appoint a Representative

You can name a relative, friend, advocate, doctor or anyone else to act for you. Some other person(s) may already be authorized under state law to act for you such as your power of attorney. The person you name would be your appointed representative.

If you want to give someone permission  to act as your appointed representative, you and that person may sign and date an Appointment of Representative (AOR) Form within 30 days of your signatures. You may also use an equivalent written notice to appoint a representative. The AOR form or equivalent written notice should be sent to the addresses provided in the Appeals section and must be included with your grievance or appeal request.

You also have the right to have an attorney ask for a coverage determination on your behalf. You can contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services, if you qualify. 

View Medicare’s Appointment of Representative Form

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