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Confidential Communication Request

Choosing who can see my Protected Health Information (PHI) and do I want it to be Confidential?

As a California Health & Wellness (CHW) member, you can request special, confidential handling of your medical information, also called protected health information (PHI). You can have CHW send any communication that has PHI directly to you instead of the main subscriber of your family's health coverage plan. This would be referred to as a Confidential Communications Request.

Communications regarding Sensitive Services means: all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender affirming care, and intimate partner violence.

PHI is health information about you. Examples of communications that include PHI are:

  • Information about your appointments.
  • Claim denials, requests for additional information about claims, and notices of contested claims.
  • The name and address of your provider, descriptions of services provided and other visit information.

Note: If you are over the age of 12, you do not require approval from your parent, guardian, or personal representative to make the Confidential Communication Request.

If you are a CHW Medi-Cal plan member and wish to request special, confidential handling of your confidential medical information:

  1. Please complete the Confidential Communication Request Form. If you previously requested special, confidential handling of your confidential medical information, but wish to revoke that request, please complete the Confidential Communication Revocation (Cancellation) Form.

    AND
  2. In your member portal, see the instructions on requesting that any communication which has PHI is communicated directly to you and will not be accessible to the main subscriber of your family's health coverage plan. Information accessible on the member portal includes claims history, authorizations and Explanations of Benefits (commonly referred to as EOBs).

Confidential Communication Request Forms