Information About Health Coverage Marketplace appeals

Getting help filing an appeal

Appoint an authorized representative for your appeal

Your representative can be a family member, friend, advocate, attorney, or someone else who will act for you. Even if you already appointed an authorized representative for your Marketplace application, you’ll need to send a new form or letter to authorize someone for your appeal.

To appoint an authorized representative, follow the instructions below.

Your request to expedite your appeal will be processed as quickly as possible. A final decision must be made as quickly as your situation requires.

You can appoint a representative either of 2 ways:

  1. Complete this form: Appoint an authorized representative for my appeal.
  2. Submit a written request with your appeal and mail it to:
    Marketplace Appeals Center
    P.O. Box 311
    Pittston, PA 18640

If you submit a written request, be sure to include:

  • Your name, address, and phone number
  • Your (case/record/request/file) number
  • A statement appointing someone as your representative
  • The name, address, and phone number of your representative
  • The professional status of your representative or their relationship to you
  • A statement authorizing the release of your personal and identifiable information to your representative
  • A statement explaining why you’re being represented
  • Your representative’s signature and the date they signed the request
 
 

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