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Authorized Representative

Appointing a Representative 

You can ask a relative, friend, advocate or doctor or anyone else to represent you. You and your representative must sign a legal letter that allows them to act for you. Your representative can file a complaint (grievance), make appointments, or make an appeal for you.

If your representative needs to request an organization determination or coverage determination, you should download the CMS-1696 Appointment of Representative Form (PDF), complete it and mail it to:

Michigan Complete Health (Medicare-Medicaid Plan)
ATTN: Medicare Appeals and Grievances
7700 Forsyth Blvd
St Louis, MO 63105

Please call Michigan Complete Health at 1-844-239-7387. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.