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

Northeast and Caribbean:
Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Virgin Islands, Vermont

Mid-Atlantic and Southeast:
Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia

Mountain, North Central and South:
Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming

Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin

Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington