The lack of control over disclosure through billing frustrates providers committed to offering confidential services to commercially-insured adolescents. Providers may attempt to educate parents about the critical role confidentiality plays in fostering an effective provider-adolescent patient relationship and hope parents do not enquire further. Some providers have successfully worked with health plans to alter EOB language to create more nonspecific service descriptions. However, laboratory billing challenges can persist. Many providers feel they must refer their commercially insured adolescent patients to Title X supported clinics. Providers should develop a community confidential services referral list with their local health department.