Eligibility and Claims
Pharmacy
Provider Directories
Forms
P4P Portal
CareAdvantage
Healthy Families
Healthy Kids
HealthWorx
Medi-Cal
San Mateo ACE
Health Education Classes
Do You Qualify?
Employment Opportunities
The Healthy Fight
History
Community Partnerships
Contact Us
FAQ
 

How to Appoint a Representative

  You Can Give Your Permission to Have Someone Represent You
Sometimes you may want or need someone to act on your behalf when you have questions or problems with your CareAdvantage benefits. These are some examples:

  When you want to make a complaint (file a grievance)
  When you want to request that HPSM approve a treatment, service, or payment for a service
  When you want to request that HPSM rethink and change their decision to not pay for a treatment or service (appeal a denial)

You can officially choose a relative, friend, doctor, or other representative to act for you in the above situations. This person is your appointed representative. Some other persons may already be appointed under State law to act for you.

  Completing the Appointment of Representative form

If you want someone to act for you, then you must sign a form that gives this person legal permission to act as your appointed representative. Your representative also needs to sign this form.

1)  Print the Appointment of Representative Form
2)  Complete, sign, and mail the form, along with your request for action, to:

Health Plan of San Mateo
701 Gateway Blvd., Suite 400
South San Francisco, CA 94080

You can call us at 1-866-880-0606 or 650-616-2174, or TTY 1-800-735-2929 (California Relay Service) to speak with a CareNavigator and learn more about appointing a representative. We are available Monday through Sunday, 8 a.m. to 8 p.m.
© Health Plan of San Mateo