Free privacy tool

Confidential communications request generator

Ask your health insurer to route EOBs, claims, portal notices, mail, email, and phone communications only to you before you use shared insurance for sensitive services.

Build your request

Everything stays in your browser. STD Ally does not store this form.

Call script

"I need to submit a confidential communications request. Please send all claim-related communications, EOBs, portal notices, mail, email, phone, and app notifications only to me. Can you confirm when that is active, and can the primary subscriber still see anything in the portal?"

Generated request

Paste this into your insurer's message center or form.

Subject: Confidential communications request

To Member Services / Privacy Office:

I am a covered individual on this health plan.

Name: [Your full name]
Member ID: [Member ID]
Plan type: Employer or family health plan

I am requesting confidential communications under HIPAA, 45 CFR 164.522(b), and any applicable state law.

Please send all communications containing protected health information, claim-related information, provider names, service descriptions, EOBs, denial notices, billing notices, portal notifications, mailed notices, email, SMS, phone calls, and app notifications only through this route:

secure portal and my personal email only

Disclosure of all or part of this information through ordinary plan communications could endanger me.

California note: This request also relates to sensitive services under California AB 1184, including sexual and reproductive health and STI-related services. Please direct all communications about sensitive services only to me.

Please apply this request to medical, behavioral health, sexual and reproductive health, STI-related services, pharmacy-related communications when handled by this plan, and any other sensitive services. If pharmacy benefits are administered by a separate pharmacy benefit manager, please tell me the exact department or company I must contact so I can make the same request there.

Please confirm in writing when this request is active and tell me whether the policyholder or primary subscriber can still see any claims, EOBs, accumulators, provider names, or service categories in the online portal.

Thank you.

This is not legal advice. Some plans require a specific form or written signature. Save confirmation and re-check before your visit.

If your plan uses a separate pharmacy benefit manager, make a separate request there too.

Use before billing insurance

The request helps only if the plan receives and applies it before claim communications are generated.

Confirm portal visibility

Ask what the policyholder can still see online: claims, deductibles, accumulators, provider names, and EOB PDFs.

Call the pharmacy plan too

Pharmacy benefits often route through a separate PBM. Prescriptions may need their own privacy request.

Sources: 45 CFR 164.522 and state privacy laws linked from the state guides. General information only, not legal or medical advice.