The difference between commercial and public insurance billing nuances for confidential, adolescent, sexual health services will be discussed. With commercial insurance, confidential sexual health services cannot be universally guaranteed. With public insurance, some states have implemented mechanisms that minimize this confidentiality breech. NY and other states have designed Medicaid family planning waivers that allow young people to retain duel coverage for reproductive health services. As a result, access to these time-sensitive and confidential services are maximized. Title X clinics will also be discussed as a viable alternative for private practitioners who do not have resources for public insurance enrollment.