Why Appoint a Representative?
You may appoint an individual (such as a relative, friend, advocate, attorney,
physician, or an employee of a pharmacy or charity) to act as your
representative so that they may file requests for a coverage determination or
appeal on your behalf.
How to Appoint a Representative
In order to appoint someone as your representative, you and your representative
must sign, date and complete an Appointment of Representative form (CMS-1696).
If the appointed representative is an attorney, only the enrollee needs to sign
the appointment of representative form or similar statement. Except in the case
of an incapacitated or incompetent enrollee, a request for a coverage
determination or re-determination from an appointed representative is not valid
until supported with an executed appointment of representative form or
Appointment of Representative form (CMS-1696)