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 form CMS-1696 (Please note: By clicking on this link, you will be leaving the Fidelis SecureLife (MMP) website.) complete it, and mail it to:
Fidelis SecureLife (MMP)
ATTN: Medicare Appeals and Grievances
7700 Forsyth Blvd
St Louis, MO 63105
Please call Fidelis SecureLife (MMP) at 1-844-239-7387. Hours are from 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.
Last Updated: 09/30/16