Naming someone to help you with an exception
In some cases, you may need another person to represent your exception or complaint.
How to name someone to help you
If you want someone else, like a family member or friend, to act for you when you make a complaint or appeal a decision, you can sign a form that makes that person your official "authorized representative." Here's how:
- Print a Medicare Appointment of Representative form from the CMS website.
- Write in the name of the person you want to act for you. Sign and date the form.
- Have your representative sign and date the form.
- Mail the form to us at:
Priority Health Medicare Coordinator
1231 East Beltline NE, MS 1115
Grand Rapids, MI 49525
You can also deliver it in person at these locations, or fax it to us at 616.975.8826, or call Customer Service..