Appoint a Representative

Elderly man using a tablet

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‚Äôs BFCC-QIO.

BFCC-QIO Contact Information by Region or State

Region 1:
Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont 

Region 2:
New Jersey, New York, Puerto Rico, Virgin Islands

Region 3:
Delaware, DC, Maryland, Pennsylvania, Virginia, West Virginia

Region 4:
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

Region 5:
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

Region 6:
Arkansas, Louisiana, New Mexico, Oklahoma, Texas

Region 7:
Iowa, Kansas, Missouri, Nebraska

Region 8:
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

Region 9:
Arizona, California, Hawaii, Nevada, Guam, N. Mariana Islands, American Samoa

Region 10:
Alaska, Idaho, Oregon, Washington