NOTICE OF
PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
The Health
Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal
program that requires that all medical records and other individually
identifiable health information used or disclosed by us in any form, whether
electronically, on paper, or orally, are kept properly confidential. This Act gives you significant new rights to
understand and control how your health information is used. HIPAA provides penalties for covered
entities that misuse personal health information.
As required
by HIPAA, we have prepared this explanation of how we are required to maintain
the privacy of your health information and how we may use and disclose your
health information.
We may use
and disclose your medical records only for each of the following purposes:
treatment, payment and health care operations.
• Treatment means providing,
coordinating, or managing health care and related services by one or more
health care providers. An example of
this would include case management.
• Payment means such activities as
obtaining reimbursement for services, confirming coverage, billing or
collection activities, and utilization review.
An example of this would be adjudicating a claim and reimbursing a
provider for an office visit.
• Health care operations include the
business aspects of running our health plan, such as conducting quality
assessment and improvement activities, auditing functions, cost-management
analysis, and customer service. An
example would be an internal quality assessment review.
We may also
create and distribute de-identified health information by removing all
references to individually identifiable information.
We may
contact you to provide information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
Any other
uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing
and we are required to honor and abide by that written request, except to the
extent that we have already taken actions relying on your authorization.
You have the
following rights with respect to your protected health information, which you
can exercise by presenting a written request to the Privacy Officer:
• The right to request restrictions on
certain uses and disclosures of protected health information, including those
related to disclosures to family members, other relatives, close personal
friends, or any other person identified by you. We are not, however, required to agree to a requested
restriction. If we do agree to a
restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to
receive confidential communications of protected health information from us by
alternative means or at alternative locations.
• The right to inspect and copy your
protected health information.
• The right to amend your protected health
information.
• The right to receive an accounting of
non-routine disclosures of protected health information.
We are
required by law to maintain the privacy of your protected health information
and to provide you with notice of our legal duties and privacy practices with
respect to protected health information.
We reserve
the right to change the terms of our Notice of Privacy Practices and to make
the new notice provisions effective for all protected health information that
we maintain. We will post and you may
request a written copy of a revised Notice of Privacy Practices from this
office.
If you
believe your privacy rights have been violated, you may file a complaint with
us by calling 419-523-4500 and asking for the Privacy Officer or by contacting
the Secretary of the Federal Department of Health and Human Services. All complaints must be also submitted in
writing. You will not be penalized for
filing a complaint.