Can someone file an appeal for me?
Contact your State Health Insurance Assistance Program (SHIP) if you need help filing an appeal.
Or, you can appoint a representative to help you. Your representative can be a family member, friend, advocate, attorney, doctor or someone else who will act on your behalf.
How to appoint a representative
- Fill out an “Appointment of Representative” form [PDF, 47.7 KB].
- Or, submit a written request with your appeal that includes:
- Your name, address, phone number, and Medicare Number
- A statement appointing someone as your representative
- The name, address, and phone number of your representative
- The professional status of your representative (like a doctor) or their relationship to you
- A statement authorizing the release of your personal and identifiable health information to your representative
- A statement explaining why you’re being represented and to what extent
- Send the representative form or written request with your appeal to the Medicare Administrative Contractor (MAC) (the company that handles claims for Medicare), or your Medicare health plan.
