Nebraska Total Care Notice of Privacy Practices

Transcription

1 Nebraska Ttal Care Ntice f Privacy Practices PRIVACY NOTICE There are times we need t use yur medical infrmatin t help yu get care. This ntice tells yu hw medical infrmatin abut yu may be used. It tells yu when we will share yur medical infrmatin with ther peple. It als tells yu hw yu can see this infrmatin. Please read it carefully. Fr help translating r understanding this please call Member Services. The phne number is , TTY: , Relay 711. Interpreter services are free fr yu. Si necesita ayuda para traducir entender este text, pr favr llame al telefn , TTY: , Rele 711. Cvered Entity Duties Nebraska Ttal Care is a Cvered Entity as defined and regulated under the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). This means that Nebraska Ttal Care has t fllw the law abut yur privacy. Infrmatin we have abut yu is called Prtected Health Infrmatin (PHI). We have t keep yur PHI private. We are required by law t give yu this Ntice. We must fllw everything in this ntice. We have t tell yu if we share yur infrmatin in a way that is nt in this ntice. This is called a breech. This Ntice tells yu hw we may use and share yur PHI. It describes yur rights t see and change yur PHI. It tells yu hw t use thse rights. If we need t use yur infrmatin in any ther ways we need yur written permissin. Nebraska Ttal Care can change this Ntice. Changes will cver yur PHI we already have and PHI we receive in the future. Nebraska Ttal Care will change and share Ntice when there is a big change t: The Uses r Disclsures Yur rights Our legal duties

2 Other privacy practices stated in the ntice. Changes will be in the Member Handbk and n ur website at NebraskaTtalCare.cm. Allwed Uses and Disclsures f Yur PHI This is a list f hw we may use r share yur PHI withut getting yur permissin first: Treatment - We may use r talk abut yur PHI with yur dctr r ther health care prvider yu are wrking with. This will help us crdinate yur treatment with prviders. It will help us decide abut prir authrizatin related t yur benefits. Payment - We may use and share yur PHI t pay yur prviders fr the services they gave yu. We may share yur PHI t anther health plan r t a health care prvider. These are als cvered entities and have t fllw the same federal Privacy Rules fr their payment. Payment activities may include: Prcessing claims Determining eligibility r cverage fr claims Issuing premium billings Reviewing services fr medical necessity Perfrming utilizatin review f claims HealthCare Operatins - We may use and share yur PHI t perfrm ur healthcare peratins. This means t d all the tasks that make sure yu get the care yu need. These activities may include: giving custmer services when yu ask fr ur help respnding t cmplaints and appeals giving yu case management and care crdinatin ding medical review f claims quality assessment and imprvement activities In ur healthcare peratins, we may share PHI with business assciates. We may share yur PHI with entities that als have t fllw privacy rules. We will have written agreements with them t prtect yur PHI. There must be a reasn fr the entity t have yur infrmatin fr their healthcare peratins. This may include: quality assessment and imprvement activities reviewing the cmpetence r qualificatins f prviders case management and care crdinatin finding r preventing healthcare fraud and abuse.

3 Grup Health Plan/Plan Spnsr Disclsures We may share yur prtected health infrmatin t a spnsr f the grup health plan. This culd be an emplyer r ther entity that is prviding a health care prgram t yu. The spnsr has t agree t certain restrictins abut hw it will use r share the PHI. Fr example, agreeing nt t use the PHI fr emplyment actins r decisins. Other permitted r Required Disclsures f Yur PHI Fundraising Activities We may use r share yur PHI fr fundraising. This culd be t raise mney fr a charitable rganizatin. Yu d nt have t participate in fundraising activities. If we cntact yu, yu can chse nt participate r stp getting cmmunicatins. Underwriting Purpses We may use r disclsure yur PHI fr underwriting purpses. This mean t help decide hw much cverage csts. We are nt allwed t use PHI that is genetic infrmatin fr this purpse. Appintment Reminders/Treatment Alternatives - We may use and share yur PHI t remind yu f an appintment. We may use and share yur infrmatin t tell yu abut treatment ptins. We may need t tell yu abut health benefits and services. This might be infrmatin abut things like hw t stp smking r lse weight. As Required by Law There are laws that say we have t share yur PHI. These can be Federal, state, and/r lcal. We will fllw the law. We will nly share what the law requires, nt anything extra. If tw r mre laws abut the same infrmatin cnflict, we will fllw the mre restrictive laws. Public Health Activities - We may share yur PHI t a public health authrity. This wuld be t prevent r cntrl disease, injury, r disability. We may share yur PHI t the Fd and Drug Administratin (FDA). This wuld be make sure the prducts they are in charge f are gd quality, safe r effective. Victims f Abuse and Neglect - We may share yur PHI if we have a reasnable belief f abuse, neglect r dmestic vilence. We wuld talk t a lcal, state, r federal gvernment authrity. This might be scial services r a prtective services agency. They are allwed by law receive these reprts.

4 Law Enfrcement - We may be required t share yur relevant PHI t law enfrcement. We wuld respnd t a: curt rder curt-rdered warrant subpena summns issued by a judicial fficer grand jury subpena We may als share yur PHI t identify r find smene. This culd be a suspect, fugitive, material witness, r missing persn. Crners, Medical Examiners and Funeral Directrs - We may share yur PHI with a crner r medical examiner. They may need it t figure ut a cause f death. We may als share yur PHI t funeral directrs if they need it t d their jb. Organ, Eye and Tissue Dnatin We may share yur PHI if yur rgans are dnated. The rganizatin that handles the dnatin may need yur PHI. We may share yur PHI with the prviders wh wrk in the dnatin and transplant prcess f: cadaveric rgans eyes tissues Threats t Health and Safety - We may use r share yur PHI if it is necessary t prtect peple frm a serius threat. This culd be a health r safety issue. If culd be fr ne persn r fr the general public. Specialized Gvernment Functins We may have t share yur PHI if yu are a member f U.S. Armed Frces. It may be require by military cmmand authrities. We may als share yur PHI: t authrized federal fficials fr natinal security t intelligence activities the Department f State fr medical suitability determinatins fr prtective services f the President r ther authrized persns Wrkers Cmpensatin There are laws abut wrker s cmpensatin and ther similar prgrams. We may share yur PHI t fllw these laws. It wn t matter wh is at fault.

5 Emergency Situatins We may share yur PHI in an emergency situatin if yu are nt able t respnd r nt present. We may share with a family member, clse persnal friend, r smene else yu chse. We may share with a prfessinal authrized t help in a disaster. We will use prfessinal judgment t decide if sharing yur PHI is best t keep yu safe. We will nly share the PHI that persn helping yu needs. Inmates We may share yur PHI if yu are an inmate f a crrectinal facility. Or, if yu are under the custdy f a law enfrcement fficial. We may share if yur PHI is needed t get yu health care, prtect yu, prtect ther peple, r the facility. Research In sme situatins we may share yur PHI t researchers. Their research study has t have been apprved. There have t be plans t make sure that yur privacy is prtected. Uses and Disclsures f Yur PHI that Require Yur Written Permissin We have t get yur permissin t share yur PHI fr sme things. There are nt many exceptins t this rule. We wuld need yur permissin in writing fr: Sale f PHI We will nt sell yur PHI withut yur permissin. Marketing We will nt use yur PHI fr marketing withut yur permissin. An exceptin is that we may talk t yu if we see yu face-t-face. We can als give yu prmtinal gifts that dn t cst much. Psychtherapy Ntes We will ask fr yur permissin t use r share therapy ntes that we have. The exceptin wuld be fr sme treatment, payment r healthcare peratin tasks. Individuals Rights These are yur rights cncerning yur PHI. T use yur rights cntact us. Cntact infrmatin is at the end f this Ntice. Right t Revke an Authrizatin - Yu may take away yur permissin t share yur PHI any time. Yu have t tell us in writing. When we have yur ntice we will stp sharing right away. Sme f yur PHI may have been shared befre we gt yur directin t stp.

6 Right t Request Restrictins - Yu have the right t ask us nt t share yur PHI. This might be that yu d nt want infrmatin shared fr in specific situatin. It might be that yu d nt want t share with specific peple. If yu ask fr restrictins we need yu t tell us the reasn. We d nt have t agree with yur request. If we agree we will d what yu asked. We will still share yur infrmatin t get yu help in an emergency. We will nt share yur PHI t a health plan if yu paid fr services yurself. Right t Request Cnfidential Cmmunicatins - Yu have the right us t change the way we cntact yu. This culd be that yu ask us t mail things t a different address. Or, that we call yu at a different number. This wuld nly apply if cntacting yu nrmally wuld put yu in danger. Yu d nt have t tell us why yu are asking fr the change. Yu d have t tell us that yu will be in danger if we d nt change ur cmmunicatin. We must accmmdate yur request if it is reasnable and we knw hw yu want us t cmmunicate with yu. Right t Access and Received Cpy f yur PHI - Yu have the right, t lk at r get cpies f yur PHI that we create. There are sme exceptins. Yu may request that we prvide cpies in a frmat ther than phtcpies. We will use the frmat yu request unless we cannt practicably d s. Yu must ask us in writing. If we say n, we will tell yu the reasn in writing. We will tell yu if ur reasn can be reviewed and hw t ask fr a review. Right t Amend yur PHI - Yu have the right t ask us t change yur PHI if yu think the infrmatin we have is wrng. Yur must ask in writing and explain why yu want it changed. There are reasns we may have t say n. If we did nt create the infrmatin we cannt change it. Yu wuld have t ask the persn wh created it t make the change. If we say n we will tell yu the reasn in writing. Yu can give us a statement telling us why yu disagree. We will attach yur statement t the infrmatin yu wanted t change. If we can change yur infrmatin we will d ur best t tell thers, including peple yu name, f the change. And t include the changes if we share infrmatin in the future. Right t Receive an Accunting f Disclsures - Yu have the right t ask wh we have shared yur PHI with fr the last 6 years. Yu can als ask wh ur business assciated shared yur PHI with. This des nt apply t sharing infrmatin fr treatment, payment, r health care peratins. It des nt apply t disclsures yu gave permissin fr and certain ther activities. If yu ask fr this list mre than nce in a 12-mnth perid, we may charge yu. This wuld be a

7 reasnable fee fr t cver the cst f the extra requests. We will give yu with mre infrmatin n ur fees if yu make a request. Right t File a Cmplaint - If yu feel yur privacy rights have been vilated yu can file a cmplaint. If yu believe that we did nt fllw ur privacy practices yu can file a cmplaint. Yu can make yur cmplaint t us in writing r by phne. The cntact infrmatin is at the end f this Ntice. Yu can als file a cmplaint with the Secretary f the U.S. Department f Health and Human Services Office fr Civil Rights. Send a letter t 200 Independence Avenue, S.W., Washingtn, D.C Call , (TTY: ). Or visit WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT. Internal Prtectins f Oral, Written and Electrnic PHI Nebraska Ttal Care prtects yur PHI. We have privacy and security prcesses t help. These are sme f the ways we prtect yur PHI: We train ur staff t fllw ur privacy and security prcesses. We require ur business assciates t fllw privacy and security prcesses. We keep ur ffices secure. We talk abut yur PHI nly fr a business reasn with peple wh need t knw. We keep yur PHI secure when we send it r stre it electrnically. We use technlgy t keep the wrng peple frm accessing yur PHI. Cntact Infrmatin Yu can call us if yu have any questins. Yu can ask us abut this Ntice, ur privacy practices r hw t use yur rights. Yu can cntact us in writing r by phne. Nebraska Ttal Care Attn: Privacy Officer 2525 N. 117 th Ave., Suite 100 Omaha, Nebraska Phne: , TTY , Relay 711