Even when the caller is able to provide the proper identification above, there are still times when releasing information is prohibited.

CSRs should not release information to spouses or ex-spouses who are not covered on the plan.

CSRs should not divulge one adult’s medical information to another adult family member, even if they are both covered on the plan.

Even the medical information of a minor child may be protected under certain state laws, most typically when the minor child was able to consent to his/her own medical care without obtaining parental consent. 

CSRs should be extra careful with topics such as mental health care, substance abuse, domestic violence, physical/mental abuse, reproductive health care (contraception, pregnancy/childbirth, abortion, diagnosis or treatment of sexually transmitted diseases, etc.).

Most claim and benefit information should be discussed without mentioning specific/private medical conditions.