Appointment of Representative

In the event of not being able to conduct the complaint or appeal you may designate a representative to carry out these efforts. To do so, the Appointment of Representative (AOR) form below must be completed in its entirety by both you and the representative that you choose. This document has a duration of one year from the date it was submitted to the healthcare plan. Once the AOR is completed, you can send it by mail, fax or bring it in person to any of our regional offices:

 

 

Medicare y Mucho Más
Appeals and Grievances

PO BOX 71114 
San Juan,
PR 00936-8014
Fax: 787-625-3375
mmm@mmmhc.com

PMC Medicare Choice
Appeals and Grievances

PO BOX 366292
San Juan, PR 00936-6292
Fax: 787-625-3375
pmc@pmc-pr.com

 

First+Plus
Appeals and Grievances


PO BOX 71114
San Juan, PR 00936-8014
Fax: 787-625-3375
mmm@mmmhc.com

 

 

Download the form: CMS Appointment of Representation Form

 

 

 

 

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