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An appointed representative is a person who can act on your behalf to request an appeal or complaint. If you need someone to file a grievance, coverage determination, organization determination, or an appeal on your behalf, you can name a relative, friend, advocate, or anyone else as your appointed representative.

Appointment of representative form for appeals and grievances. If you are filing an appeal or grievance on behalf of a member, you need an Appointment of Representative (AOR) form or other appropriate legal documentation on file with Humana so that you are authorized to work with Humana on his or her behalf.

Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.

Appointment of Authorized Representative (Purpose: To grant permission for another individual or company to act on your behalf in filing a Grievance or Appeal).

If you decide to appoint someone to help you with your case, you must tell us in writing. You can sign and submit a written statement appointing the person, or use our standard form SSA-1696, Appointment of Representative.

To be appointed as the applicant's representative, the case manager must complete the SSA-1696: Appointment of Representative form.

Appointment of Authorized Representative Use this form to appoint an individual or organization as your Medi-Cal authorized representative. Your authorized representative may act for you on all duties related to your Medi-Cal eligibility and enrollment. Or, you may also limit duties.