As a Medicare beneficiary, you have the right to appoint a representative if you need help filing an appeal or complaint. Your representative can be a family member, friend, advocate, attorney, doctor, or anyone else you trust to act on your behalf.
To appoint a representative, fill out an Appointment of Representative form and submit it to your Beneficiary and Family Centered Care-QIO (BFCC-QIO) by mail or fax. See below to find your state’s BFCC-QIO.
BFCC-QIO Contact Information by Region or State
Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont
New Jersey, New York, Puerto Rico, Virgin Islands
Delaware, DC, Maryland, Pennsylvania, Virginia, West Virginia
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Iowa, Kansas, Missouri, Nebraska
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Arizona, California, Hawaii, Nevada, Guam, N. Mariana Islands, American Samoa
Alaska, Idaho, Oregon, Washington