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Appoint a Representative - Align Senior Care

Members Resources

Find tools, information, and other resources to help you get the most out of your benefits with Align Senior Care.

Appoint a Representative

You or someone you name may file a complaint (grievance) or appeal for you. The person you name would be your “appointed representative”. You may name a relative, friend, lawyer, advocate, health care provider, or anyone else to act on your behalf.

To appoint a representative, fill out CMS Appointment of Representative Form (CMS Form-1696).

Print and mail the form to:

Align Senior Care
Appeals and Grievances Department
PO Box 4440
Glen Allen, VA 23058

You may also send a fax to 1-833-610-2380

For a description of, and information on how to appoint a representative, you may also call Member Services at:

  • California: 1-844-305-3879 (TTY 711)
  • Florida: 1-844-788-8935 (TTY 711)
  • Michigan: 1-855-855-0336 (TTY 711)
  • Virginia: 1-855-855-0489 (TTY 711)