How to Appoint a Representative

You can name a relative, friend, advocate, doctor or anyone else to act for you. The individual 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 must complete an Appointment of Representative (AOR) Form.

You may also use an equivalent written notice to appoint a representative. The AOR form or written notice with the same information that is needed in the AOR should be sent to the addresses in the Appeals section. This information must be included with your grievance (complaint) or appeal (ask us to review a request again) request.

You also have the right to have a lawyer 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.

Document Download (PDF)
Appointment of Representative Form

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