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.
If you have questions about appointing a representative,