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Mental Health / Employee Assistance Programs (EAP)

Mental Health / Employee Asssistance Programs (EAP)

Select a form below to submit a request related to behavioral health, mental health, substance abuse, Life Solutions, and Employee Assistance Program (EAP) benefits that are managed by Optum. For assistance with healthcare information managed by other Optum areas such as Interactions with an Optum Nurse, Optum Home Delivery Pharmacy, Chiropractic, and/or Physical/Occupational Therapy, go to the “Forms” page and select the appropriate area.

If you are unable to find the form you need or have questions, call the phone number on the back of your health plan ID card.

What would you like to do?

Get it

  • I’d like to request a copy of my healthcare information maintained by Optum. Click here to submit a request.

Change it

  • I’d like to change my address, phone number or billing information associated with my account. Do not complete a form through this site. Call customer service at the telephone number located on your health plan ID card or your employer group, or update the information through your online account (where applicable).
  • I’d like to request an amendment or correction of my healthcare information maintained by Optum. Click here to submit a request.
  • I’d like to request communications of my healthcare information be sent to an alternative location because I have concerns about my safety (known as a confidential communication), or I’d like to change or remove a prior request. Click here to submit a request.

Share it

  • I’d like to request a restriction of the use and disclosure of my healthcare information. Click here to submit a request.
  • I’d like to allow someone else (person or place) to have access to my healthcare information, speak on my behalf, or help manage it for me OR I am a guardian, legal representative, or Medical Power of Attorney for someone else, and want to help manage their healthcare information.
    Go to the "Managing your health" section of Live and Work Well to locate the hyperlink to the Release of Information form. This link can be located under “Benefits & Services” and then “Forms.”
  • I’d like to stop sharing my healthcare information with someone else (person or place) I previously authorized to have access to it, speak on my behalf, or help manage it for me. Click here for a form you can complete to submit a request.

Monitor it

  • I’d like to request a list of who my healthcare information has been released to for purposes outside of treatment, payment, or healthcare operations. Click here to submit a request.
  • I believe that my privacy rights have been violated and I’d like to file a complaint. We will not take any action against you for filing a complaint.
    • Via email at privacy@optum.com.
    • Via mail at:
      Optum
      Privacy Administrator
      MN101-E013
      11000 Optum Circle
      Eden Prairie, MN 55344
    • You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint.
  • I’d like to obtain a copy of the Notice of Privacy Practices (NPP) outlining how my healthcare information may be used and/or disclosed.
    • If you are enrolled in an insured plan offered by UnitedHealthcare, click here.
    • If you are enrolled in an insured plan offered by UnitedHealthcare Community & State, click here.
    • If you are enrolled in an insured plan offered by US Behavioral Health Plan, California ("USBHPC"), click here.
    • For all others, contact your plan directly.