Form 216-B. (7/11). APPOINTMENT OF AUTHORIZED REPRESENTATIVE. Complete this section only if someone other than the covered person is appealing. The ...

Appointment of Representative. Customer Name (print). Date of Birth ... If the person signing this form is not the customer, explain who they are in ...

Find all the forms you will need to help you manage your Cigna Healthcare Medicare plan throughout the year.

You may represent yourself, or you may ask another person, including your treating health care provider, to act as your authorized representative. You may ...

Supporting legal documentation, such as a power of attorney that indicates full health care decision-making authority or guardianship papers, must be submitted ...

Edit, sign, and share cigna authorized representative form online. No need to install software, just go to DocHub, and sign up instantly and for free.

Be sure to include any supporting documentation, as indicated below. Address: Fax Number: Cigna Medicare Advantage Appeals. Standard: 1-855-350-8671.

4 дня назад · Find health insurance forms for customers including medical and dental claims forms, authorization forms, appeals, pharmacy forms, and more.

Cigna Appointment of Representative Form. Check out how easy it is to complete and eSign documents online using fillable templates and a powerful editor.

Complete the top section of this form completely and legibly. Check the box that most closely describes you as the requestor.