Member Privacy Notice
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At Advicare we know that your personal health information is private. This notice is to inform you that we are required by law to protect your health information and records. Please review this notice and if you have any questions please call our Member Services Department at 1-888-781-4371.
By law we must:
- Make sure that your protected health information is kept private
- Give you this notice to tell you about our legal duties and privacy practices, and
- Follow the terms of this notice.
Protected Health Information (PHI) is defined as any oral, written or electronic information that:
- Identifies you or can be used to identify you.
- Either comes from you or has been created or received by a health care provider, a health plan, or a healthcare clearinghouse.
- Has to do with your physical and/or mental health or condition, providing health care to you, or paying for providing health care to you.
Here are some ways we are required to use or share your PHI.
- Treatment- For example, we may use or share your PHI to enroll you in a Case Management program.
- Payment to Caregivers- to help get your health care bills paid. For example, we may receive data from your doctor that identifies you, your illnesses, or the treatment, tests or supplies that might have been used.
- Health Care Operations- in order to run our business. Only the employees that need to view your PHI are allowed to see or talk about your PHI. For example, we may use your PHI to review and improve the quality of health care services you receive. In addition, Advicare shares your PHI with our business partners; however, they are under the same requirements as we are to protect your PHI.
- Another covered person or group’s needs- We may share your PHI with another covered person or group, such as a doctor or health plan, for their treatment or payment use. For example, we may share your PHI with a health plan to help them pay for your care. We may also share your PHI with them so that they can do certain business tasks if you have or have had a relationship with them.
- To remind you of appointments and health–related benefits or services – We may use your PHI to inform you of an appointment or to tell you about other health care treatment, services, or benefits.
We may be required to give your PHI to others:
- To comply with the law- If required by law to do so in a court or other legal process. For example, we will release PHI if a law says that we must report PHI about people who have been abused.
- To report public health activities- When government officials are collecting certain PHI. For example, we may share PHI about births, deaths, and some diseases.
- For health oversight activities- When a government agency is conducting activities approved or required by law, such as audits, investigations, licensure or disciplinary actions. Oversight agencies include government agencies that look after the health care system, and benefit programs, including Medicaid or other government programs.
- To coroners, medical examiners and funeral directors – to help name a dead person, and if permitted by law, to organizations that help find organs, eyes, and tissue to be donated or transplanted.
- To avoid harm- In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement or others who may be able to stop or lessen the harm.
- To the government for security – We may share PHI for national security reasons. For example, we may share PHI to protect the President of the United States.
- About injuries on the job – We may share PHI to obey workers’ compensation laws.
- Lawsuits and disputes- If you are involved in a lawsuit or a disagreement, we may share PHI about you in response to a court order, or other lawful process.
- For Research- We may share your PHI with researchers when a review board or privacy board has followed the HIPAA information requirements.
Other Uses and Sharing of Your Health Information
We will ask for your written permission before we make any use or release of your PHI not described in this notice. If you give us your written permission, you may still decide later that you no longer want us to use or release your PHI in that way. If you change your mind, you may tell us in writing. We will then stop using your PHI in that way.
Sharing Your PHI with your Family, Friends, or Others
We may share PHI about you with a friend or family member who is involved in your care or who helps pay for your care when you are present. For example, if one of our case managers visits you in the hospital and your mother is with you, we may discuss your PHI with you in front of her. We will not discuss your PHI with others if you tell us not to. There may be times when you are not present or are unable to make healthcare decisions. If this should happen, we may share your PHI if we think it is best for you. For example, we may share PHI with someone who is with you when you are unconscious so that you can receive care.
Your Rights under Federal Law with Respect to PHI
The law gives you the following rights regarding your PHI. To use these rights, please call Member Services at 1-888-781-4371.
- You can see or get copies of some of your PHI. Sometimes your right to see or get copies of your PHI may be limited. You must ask us in writing. You may obtain a paper copy of this notice at any time. Please call Member Services at 1-888-781-4371.
- You may ask us to limit our uses and releases for purposes of treatment, payment or healthcare operations. We are not required to agree to the request. You may also ask us to limit releases to someone who is involved in your care or payment for your care, like a family member or friend.
- You may ask us to send your PHI to another address if it is necessary to protect you from danger. You may ask us to discuss your PHI with you in a certain way if it is necessary to protect you from danger. For example, you may ask us to send PHI to you at work instead of at home. You may ask us to send your PHI by e-mail rather than regular mail. You must tell us in writing what you want. You must tell us that you could be in danger if we do not agree to your request.
- You can get a list of certain releases we have made of your PHI. The list will only include releases made after April 14, 2003. The list will not include certain types of releases.
- You may ask us to correct your PHI if you think there is a mistake. You must ask us in writing and tell us why you want us to correct the information.
- You may get a paper copy of this notice at any time. To obtain a paper copy of this notice, please call Member Services at 1-888-781-4371. Please allow 30 days for us to send this notice to you.
- You do not have the right to get certain types of health records such as:
- Records that have psychotherapy notes
- Records collected for use in a court case or other legal action
- Records subject to federal laws about biological products and clinical laboratories
If you believe we have violated your privacy rights you may file a complaint. You will not be penalized for filing a complaint. You may send your written complaint to:
Advicare, Member Services, 531 South Main Street, Suite RL-1, Greenville, SC 29601
You may send a written complaint to the Secretary of the Department of Health and Human Services at:
Office for Civil Rights, U.S. Department of Health and Human Services, Sam Nunn Atlanta Federal Center, Suite16T70, 61 Forsyth St, Atlanta, GA 30303-8909
If Your Rights Change
We may change this notice and our privacy policies at any time. Then the new notice will apply to your entire PHI. We will make the new notice available to you at all times. The new notice will contain the new effective date.