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  • Confidential Communication Request Form ... - Axa

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CONFIDENTIAL COMMUNICATION REQUEST FORM This form is for use by a person who is covered by health insurance and wishes to make a reasonable request to receive communications of insurance claim-related.

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Examples of this kind of communication include conversations between a married couple, a doctor and patient, and an attorney and their client. These conversations are recognized to be private by the law and are protected from disclosure, unless one of the parties waives this protection.

A confidential communication request is a request that communications be sent to the patient rather than policy holder at an alternate address or through an alternate mode of communication such as email.

Confidential Communication Request Explanation of benefits notices (EOBs). 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.

A member may, but is not required to, request confidential communications by completing a Confidential Communications Request form. Call Customer Care at (855) 699-5557 (TTY:711) for assistance and to request the form be mailed to you. You can also find and download the form online at blueshieldca.com/promise/medi-cal.

A confidential communication request is a request that communications be sent to the patient rather than policy holder at an alternate address or through an alternate mode of communication such as email.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232