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MEMBER RESOURCES > APPEALS OR EXCEPTIONS

Appoint a representative, file a grievance or appeal,
request a coverage determination, and more.

Member Portal Find a Provider or Pharmacy Find a Drug
File an AppealRequest an Organization DeterminationObtain Aggregate Number of AppealsFile a GrievanceRequest a Coverage DeterminationAppoint a RepresentativeRequest a Reconsideration

Name an Appointed Representative

 

You can file a grievance or an appeal yourself. You can also choose someone to do this for you. This person is called your appointed representative.

Your appointed representative can be:

  • A family member
  • A friend
  • A lawyer or advocate
  • Your doctor or another health care provider
  • Anyone you trust to act for you

To name an appointed representative, complete the CMS Appointment of Representative Form (CMS Form CMS-1696).

Send the completed form to:

Mail:

Align Senior Care
Appeals and Grievances Department
PO Box 40
Glen Burnie, MD 21060

Fax: 1-833-610-2380

If you need help or have questions, call Member Services:

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