Get an Appointed Representative
Any person you appoint, such as a family member, friend, or your doctor, may help you:
- Request a coverage determination or an appeal
- File a quality of care concern
You must first complete the “Appoint a Representative” form (CMS Form Number 1696)".
If you have questions about appointing a representative, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
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