Privacy - Notice of Privacy Pactices

Effective Date: June 14, 2005

If you have any questions about this notice, please call the Member Services Department at Mid Rogue Community Health Plan (MRCHP) at (541) 471-4106. The address is740 SE 7 TH Street, Grants Pass, Oregon 97526.

WHO WILL FOLLOW THIS NOTICE

This notice describes the information privacy practices followed by our employees at MRCHP. We are required by law to abide by the terms of the notice currently in effect.

YOUR HEALTH INFORMATION

This notice applies to the information and records we have about your health, health status and the healthcare and services you have received. Your health information may include information received by this office; may be in the form of written or electronic records or spoken words; and may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity, referrals, and similar types of health-related information. We are required by law to maintain the privacy of your health information and to give you this notice. It will tell you about the ways in which we may use and disclose health information about you, as well as describe your rights and our obligations regarding the use and disclosure of that information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

We may use and disclose health information for the following purposes:

FOR TREATMENT

While we do not provide on-site treatment services, we may use or disclose health information about you for the treatment purposes of other healthcare providers. For example, your provider may need to verify your medical history to prescribe certain medication.

FOR PAYMENT

We may use and disclose health information about you so the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health information about a service you have received by a physician to your health plan so that your health plan will pay that physician. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will pay for a treatment.

FOR HEALTHCARE OPERATIONS

We may use and disclose health information about you in order to run our office and to make sure that you and other members receive quality care. For example, we may use your health information to evaluate the performance of our staff in serving you, safeguarding the quality of care being provided to you by your physician and others, and the credentialing of physicians and other associated providers; to evaluate requests for services as to their appropriateness as defined by your benefit package; and to improve care, reduce cost, coordinate and manage healthcare and services, train staff and comply with the law.

HEALTH-RELATED PRODUCTS AND SERVICES

We may tell you about health-related products or services that may be of interest to you. For example, we may notify you about healthcare fairs that will provide special health screening examinations or provide specific health information that you may want. We may contact you about special preventative healthcare programs such as smoking cessation classes. Please contact us if you do not wish to be contacted about these services. If you advise us in writing at the address listed at the top of this Notice that you do not wish to receive such communications, we will not use or disclose your information for these purposes.

SPECIAL SITUATIONS

We may use or disclose health information about you for the following purposes, subject to all applicable legal requirements and limitations:

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY

We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

REQUIRED BY LAW

We will disclose health information about you when required to do so by federal, state, or local authorities.

MILITARY, VETERANS, NATIONAL SECURITY AND INTELLIGENCE

If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you.

WORKERS COMPENSATION

We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

HEALTH OVERSIGHT ACTIVITIES

We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.

LAWSUITS AND DISPUTES

If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.

LAW ENFORCEMENT

We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

INFORMATION NOT PERSONALLY IDENTIFIABLE

We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

FAMILY AND FRIENDS

We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances based on our professional judgment that you would not object. In situations where you are not capable of giving consent, we may use our professional judgment to determine that a disclosure to your family member or friend is in your best interest.

CORONER, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS

We may disclose your health information to coroners and medical examiners for their lawfully authorized purpose, such as determining cause of death. Consistent with applicable law, we may disclose your health information to funeral directors as necessary to carry out their duties with respect to the decedent.

ORGAN PROCUREMENT ORGANIZATIONS

We may disclose your health information to organ procurement organizations or other similar organizations for the purpose of facilitating organ, eye, or tissue donation and transportation.

RESEARCH ACTIVITIES

Consistent with applicable law, we may disclose your health information for research purposes.

CORRECTIONAL FACILITIES AND INMATES

Under certain limited circumstances, we may disclose your health information to a correctional institution.

OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific written authorizations. If you give us authorization to use or disclose health information about you, you may revoke that authorization in writing at any time. If you revoke your authorization we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission. In some instances, we may need specific written authorization from you in order to disclose certain types of specially protected information such as HIV, substance abuse, mental health, and genetic testing information.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your health information maintained by MRCHP: You have the right to inspect and copy your health information such as medical and billing records that we keep and use to make decisions about your care. You must submit a written request to MRCHP’S Member Service Department in order to inspect and/or copy records of your health information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. We have the right to take 30 days to make your records available to you. We may deny your request to inspect and/or copy records in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review. If you believe the health information we have about you is incorrect or incomplete, you may ask to amend the information. You have the right to request an amendment as long as this office keeps the information. To request an amendment complete and submit a Medical Record Amendment Correction Form to MRCHP’S Member Services Department. We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:We did not create, unless the person or entity that created the Information is no longer available to make the statement; Is not part of the health information that we keep; You would not be permitted to inspect and copy; or Is accurate and complete.

RIGHT TO AN “ACCOUNTING OF DISCLOSURES”

You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you for purposes other than payment, healthcare operations, and a limited number of special circumstances involving national security, correctional institutions and law enforcement. The list will also exclude any disclosures we have made based on your written authorization. To obtain this list, you must submit your request in writing to MRCHP’S Member Services Department. It must state a time period, which may not be longer than six years and may not include dates before June 14, 2005. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

RIGHT TO REQUEST RESTRICTIONS

You have the right to request restrictions or limitations on the health information we use or disclose about you for payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, such as a family member or friend.

WE ARE NOT REQUIRED TO AGREE TO YOUR REQUEST

If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or we are required by law to use or disclose the information. To request restrictions, you need to complete and submit the Requestfor Restrictionon Use/Disclosure of Medical Information to MRCHP’S Member Services Department.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you may complete and submit the Request for Restriction on Use/Disclosure of Medical Information and/or Confidential Communication to MRCHP’S Member Services Department. We will not ask you the reason for your request. We accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

RIGHT TO A PAPER COPY OF THIS NOTICE

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are entitled to a paper copy. To obtain such a copy, contact MRCHP’S Member Services Department.

CHANGE TO THE NOTICE

We reserve the right to change this notice, and to make the revised or changed notice effective for the medical information we already have about you as well as any information we receive in the future. We will post the current notice in the office with its effective date. You are entitled to a copy of the notice currently in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, notify MRCHP’S Member Services Department at (541) 471-4106. You will not be penalized for filing a complaint.

©2008 Mid Rogue Health Plan All Rights Reserved.
Last Updated 08/13/2008 | H3810_H2481_MKT_0801