Identify the plan and the type of request
BCBSTX separates its group, individual and Medicare privacy forms from Medicaid forms. Its index also lists authorization to share information, restrictions and confidential communications as different requests.
Use the member card to ask which form applies to your plan. If you only need to correct a mailing address, follow that ordinary process. The confidential communication form is not a substitute for every address or account-setting change.
Sources: BCBSTX: Privacy practices and forms; BCBSTX: Confidential Communications Request Form
Describe the alternate arrangement accurately
The form’s initial-request criteria include a reasonable alternative communication location or method, a statement about endangerment and an explanation of how applicable payments will be handled.
Read those questions carefully and answer them truthfully. Identify the contact arrangement you are requesting and ask the insurer to explain any unclear field. Do not select an endangerment statement that is untrue merely to obtain a different mailing address.
Complete the appropriate request and signature sections
The form distinguishes an initial request, modification of an existing request and termination. It requires the appropriate signature and may require supporting legal documentation when a personal representative signs.
Keep a copy of the completed version and use the current submission instructions. If you are helping another adult, let the insurer explain what authority is needed before signing or sending that person’s information. Keep private identifiers out of a clinical practice’s general inquiry form.
Confirm the decision and the communications it changes
The form describes a written determination. It also says a granted request applies to current coverage and identifies coverage changes that require a new request.
Ask which mailings or other communications are affected, when the arrangement takes effect and how to check it after a coverage change. Confirm clinic reminders separately. A submitted request is not a guarantee that every explanation of benefits, account view or outside organization’s message is hidden.
Your next-step checklist
- Confirm the plan-specific privacy form.
- Distinguish an initial request, modification, termination and ordinary address change.
- Describe the requested communication and payment arrangement accurately.
- Complete the proper signature and any representative documentation.
- Keep the written determination and recheck when coverage changes.
Keep personal, insurance and medical information in the appropriate organization’s approved secure channel.
Common questions
Will this change the messages sent by my clinic?
Do not assume so. The form addresses BCBSTX and its business associates’ communications. Ask the clinic separately about its reminders, statements and contact preferences.
Can I use the same form for every BCBSTX product?
BCBSTX directs Medicaid members to separate privacy forms. Confirm the form for your actual plan using the current privacy index or member-service contact.
Sources: BCBSTX: Privacy practices and forms
Sources and verification
The sources below support the administrative information in this guide. Follow the responsible organization’s current instructions when requirements, forms or contact routes change.
- BCBSTX: Privacy practices and forms — checked .
- BCBSTX: Confidential Communications Request Form — checked .