Confidential Dental Communication Request

As a Health Net Dental member, you can request special, confidential handling of your dental information, also called protected health information (PHI). You can have Health Net send any communication that has PHI directly to you at alternate address of your choosing. This would be referred to as a Dental 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.

If you are over the age of 12 you do not require approval from your parent, guardian, or the main subscriber of your family’s dental plan coverage to make this request.

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

1. Please complete the Dental Confidential Communication Request Form. If you previously requested special, confidential handling of your confidential dental information, but wish to revoke that request, please complete the Revoke Dental Confidential Communication 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 dental plan coverage. Information accessible on the member portal includes claims history and authorizations.