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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.

2 ways to appoint a representative

  1. Fill out an "Appointment of Representative" form.
  2. Submit a written request with your appeal. Be sure to include:
    • Your name, address, and phone number
    • Your Medicare number
    • A statement appointing someone as your representative
    • The name, address, and phone number of your representative
    • The professional status of your representative 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
    • Your signature and the date you signed the request
    • Your representative's signature and the date they signed the request

At some levels in the appeals process, your doctor or prescriber (for prescription drug appeals) can make a request on your behalf without being appointed as your representative.

If you have questions about appointing a representative, call 1-800-MEDICARE.

Note
  • Write your Medicare number on all documents you submit with your appeal request.
  • Keep a copy of everything you send to Medicare as part of your appeal.