Right to receive confidential communications

Blue Shield of California Promise Health Plan communications may contain your protected health information (PHI). You can ask to have Blue Shield Promise communications with your PHI sent directly to you at the mailing address you choose. To make this request, submit a Confidential Communications Request form, which can be found here:

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Notice about confidential communication requests:

Members who may consent to receive sensitive services are not required to obtain any other member’s, subscriber’s, or policyholder’s authorization to receive sensitive services or to submit a claim for sensitive services. Blue Shield Promise will direct communications regarding sensitive services to a member’s alternate designated mailing address, email address, or telephone number or, in the absence of a designation, in the name of the member at the address or telephone number on file. Blue Shield Promise will not disclose medical information related to sensitive services to any other member, subscriber’s, or policyholder’s without written authorization from the member receiving care. Blue Shield Promise will accommodate requests for confidential communication in the form and format requested, if it is readily producible in the requested form and format, or at alternative locations. A member’s request for confidential communications related to sensitive services will be valid until the member revokes the request or submits a new request for confidential communications.

A confidential communication request may be submitted in writing to Blue Shield Promise at the mailing address, email address, or fax number at the bottom of this page. 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.

The confidential communication request shall apply to all communications that disclose medical information or provider name and address related to receipt of medical services by the individual requesting the confidential communication.

You may return the completed and signed form to the Blue Shield of California Privacy Office using one of these options:

  • Mail: Blue Shield of California Privacy Office
    PO Box 272540
    Chico, CA, 95927-2540
  • Email: privacy@blueshieldca.com
  • Fax: (800) 201-9020

 

If received by email or fax, your request for confidential communications will take effect within 7 calendar days of receipt. If received by first-class mail, your request will take effect within 14 calendar days of receipt. If you contact us about your request, Blue Shield Promise will acknowledge receipt of your confidential communications request and will advise you of the status of your request.

The confidential communication request will apply to all communications that disclose medical information or provider name and address related to receipt of medical services by the member requesting the confidential communication.

Page last updated: 9/12/2022

Health Care Options: (844) 580-7272  {TTY: {800) 430-7077}, Monday through Friday from 8 a.m. — 6 p.m. 

For information on Blue Shield Promise plans for your health care, call the Department of Health Care Services at (800) 430-4263 {TTY: (800) 735-2922}, or visit https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal Plans.

© 2002-2024. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. All rights reserved.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

 

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, 
Long Beach, CA  90806

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