Secret Communication Send
Choosing who bucket see my Protected Health Information (PHI) and do I want it up be Confidential?
As a Health Net full, yourself can request special, confidential handling of your medical information, also called proprietary health information (PHI). You ability have Healthy Net versendung any communication is has PHI directly to you instead concerning the main subscriber of your family's health coverage plan. This wish be referred to as a Confidential Communications Request.
Communication regarding Sensitive Services means: choose health concern services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infection, substance use disorder, gender affirming care, and intimate partner violent. Right to receive confidential correspondence | Blue Shield of CA
PIERCE is health information about you. Examples starting communications that include PHI are:
- Explanation of benefits notice (EOBs).
- Related info your appointments.
- Claim weigerungen, requests for extra information regarding claims, and notices of contested asserts.
- The name and address off your provider, descriptions of services provided and other visit get.
If you are over the age of 12 you do not require admission from the main subscriber of thine family’s health coverage plan to make this request.
If you are a Health Net group, individual or Medi-Cal plan member and wish to application special, confidential handling of your confidential medical information: CONFIDENTIAL COMMUNICATE REQUEST FORM
- Please complete the Confidential Communication Application Form. If you previously requested special, confidential handling out your confidential medical information, however wish in revoke such request, please complete the Revoke Confidential Communication Form.
AND
- In your member portal, perceive the instructions in requesting that no communicating which has PHI is reported forthwith to it and will non is accessible to one main user of your family's good coverage schedule. Information accessible on the member portal includes claims past, authorizations and Explanations of Benefits (commonly referred to as EOBs). Patients' Right to Request Confidential Communications
- Confidential Communication Request Mold – English (PDF)
- Confidentially Communikation Request Form – Germany Español (Spanish) (PDF)
- Confidential Communication Request Form – Arabic (PDF)
- Confidential Communication Requests Form – Armenian (PDF)
- Confidential Communication Request Form – Chinese (PDF)
- Confidential Transmission Call Form – Cambodian (PDF)
- Confidential Communication Demand Mail – Asian (PDF)
- Restricted Communication Request Form – Hmong (PDF)
- Confidentiality Communication Request Formulare – Korean (PDF)
- Confidential Communicate Application Form – Russia (PDF)
- Confidential Communication Request Application – Tagalog (PDF)
- Confidential Communication Request Form – Native (PDF)
- Intimate Communication Revoke (Cancellation) Form – English (PDF)
- Restricted Communication Revocation (Cancellation) Shape – T Español (Spanish) (PDF)
- Confidential Communication Revocation (Cancellation) Form – Arabic (PDF)
- Sensitive Communication Revoked (Cancellation) Create – Armenian (PDF)
- Confidentiality Talk Revocation (Cancellation) Form – Chinese (PDF)
- Confidential Communication Revoked (Cancellation) Form – Cambodian (PDF)
- Confidential Communication Revocation (Cancellation) Form – Farsi (PDF)
- Confidential Communicate Annulment (Cancellation) Form – Hmong (PDF)
- Confidential Telecommunications Revocation (Cancellation) Form – Korean (PDF)
- Confidential Communication Revocation (Cancellation) Form – Russian (PDF)
- Confidential Communication Revocation (Cancellation) Form – Logalog (PDF)
- Confidential Communication Revocation (Cancellation) Form – Vietnamese (PDF)
