A Confidential Information Release Form does not allow the person you indicate to change or cancel your insurance policy, or to submit health care appeals or grievances on your behalf. To change or cancel a policy, apply for coverage or otherwise manage your policy, we need a Power of Attorney.
Please be aware that there are different types of Powers of Attorney, and they can authorize different things. A Health Care Power of Attorney will allow us to share your health information with the person indicated on the form, and also let that person manage your health care matters. A Durable Power of Attorney or Financial Power of Attorney typically doesn’t cover health care matters, but it may.
Please note that the above chart is very general. Power of Attorney documents vary, so we need to review the individual documents to see what they authorize.
If you have a Power of Attorney that you want us to recognize, please send it to our Privacy Office. You can mail it to: Blue Cross Blue Shield of Arizona, Attention Privacy Office, PO Box 13466, Phoenix, AZ 85002-9985; you can fax it to (602) 864-3152 or you can email it to email@example.com.
Please be sure to include a complete copy of the form. We will review it to see what powers you have given to the person indicated on the form.
If the Power of Attorney is acceptable, we will put it on file allowing the person designated on the form to manage your policy and receive your information.
If the Power of Attorney does not appear to be acceptable or is incomplete, we will send you a letter asking for a valid form or all pages of the document. If the Power of Attorney only covers financial matters, we will also include a Confidential Information Release form with our letter to you.