HIPAA/Privacy Information
Notice of Privacy Practices for the Use and Disclosure of Private Health Information (PHI)
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.
WHA is required by law to maintain the privacy of your health information and to provide you this Notice about our legal duties and privacy practices. We must follow the privacy practices described in this Notice while it is in effect. This Notice takes effect April 14, 2003, and will remain in effect until we replace or modify it.
Protecting Your Privacy
At WHA, we understand the importance of keeping your health information confidential and we are committed to use your health information consistent with State and Federal law. This Notice explains how we use your health information, and describes how we may share your health information with others involved in your health care. This Notice also lists your rights concerning your health information and how you may exercise those rights.
Protected Health Information (PHI)
For the purposes of this Notice, "health information" or "information" refers to Protected Health Information. Protected Health Information is defined as information that identifies who you are and relates to your past, present, or future physical or mental health or condition, provision of care, or payment for care. The information we use and share includes, but is not limited to:
- your name and address;
- personal information about your circumstances;
- medical care given to you; and
- your medical history.
WHA uses and shares your health information for the purposes of treatment, payment, health care operations, and other uses permitted or required by Federal, State, or local law. In instances where your health information is not used for such purposes, WHA would require your written authorization prior to sharing it.
Treatment
WHA may use or disclose your health information to health care providers (doctors, hospitals, pharmacies and other caregivers) who request it in connection with your treatment without your written authorization. For example:
- We may share information with physicians, nurses, other health-care professionals, and your medical group or hospital when necessary for you to receive appropriate care and treatment.
WHA may use and disclose your health information for the purposes of payment of the health care services you receive, without your written authorization. This may include claims payment, eligibility, utilization management, and care management activities. For example:
- We may provide your eligibility information to your medical group so they are paid accurately and timely, or to a third party entity to ensure that your doctor or hospital is paid accurately and timely.
- We may share information about you to a hospital to ensure that claims are billed properly.
WHA may use and disclose your PHI in order to administer our health plan. For example, WHA may use and disclose your health information to support various business activities without your written authorization. Health care operations are activities related to the normal business functions of WHA. For example, we may share information with others for any of the following purposes:
- Quality management and improvement activities in order to review and improve the quality of health care services you receive;
- Planning and general administration;
- Research and studies, such as member satisfaction surveys;
- Compliance and regulatory activities;
- Risk management activities;
- Population and disease management studies and programs; and
- Grievance and appeals activities.
WHA may use or disclose your health information without your written authorization, for the following purposes under limited circumstances:
- To State and Federal agencies that have the legal right to receive data, such as to make sure WHA is making proper payments and to assist Federal/State Medicaid programs. As required otherwise by Federal, State, or local law;
- For public health activities, such as births, deaths, and reporting disease outbreaks or disaster relief. We may provide coroners, medical examiners, and funeral directors information that relates to a person's death;
- For government healthcare oversight activities, such as fraud and abuse investigations or the Food and Drug Administration (FDA);
- For judicial, arbitration, and administrative proceedings, such as in response to a court order, subpoena, or search warrant. For law enforcement purposes, such as providing limited information to locate a missing person;
- To a probate court investigator to determine the need for conservatorship or guardianship;
- For research studies that meet all privacy law requirements, such as research related to the prevention of disease or disability;
- To avoid a serious and imminent threat to health or safety;
- To contact you about new or changed benefits under Medicare and/or WHA;
- To contact you to remind you of visits/deliveries;
- To create a collection of information that can no longer be traced back to you;
- For purposes when issues concern child or elder abuse and neglect;
- For specialized government functions, such as providing information for national security and military activities;
- To Workers' Compensation claims or authorities as required by State Workers' Compensation laws;
- To the Plan Sponsor of a Group Health Plan or employee welfare benefit plan;
- To law enforcement officials if you are an inmate or under custody. These would be permitted if needed to provide medical services to you or for the protection and safety of others; and
- To friends or family members who are assisting you with your health care, with confirmation of that status.
Sharing Your PHI with Others
As part of normal business, WHA shares your information with contracted Plan Providers (i.e. medical groups, hospitals, pharmacy benefit management companies, social service providers, etc.). In all cases where your PHI is shared with Plan Providers, we have a written contract that contains language designed to protect the privacy of your health information. Our Plan Providers are required to keep your health information confidential, and protect the privacy of your information in accordance with State and Federal law.
Your Rights With Respect to Your PHI
You may give us written authorization to use your PHI or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. However, your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
The following are your rights with respect to your health information. If you would like to exercise any of the following rights, please refer to the section below titled, "How to Obtain Additional Information About This Notice."
Right to Request Restrictions
You have the right to ask us to restrict how we use and disclose your information for treatment, payment, or health care operations as described in the Notice. You also have the right to ask us to restrict information that we have been asked to give to family members or to others who are involved in your health care. However, we are not required to agree to these restrictions. If we deny your request, we will notify you in writing with the specific reason(s) the request was denied. If we do agree to your request to restrict health information, we may not use or disclose your PHI for that purpose, except as needed to provide treatment in an Emergency. We also do not have to honor your restriction if we are required by law to disclose the information or when the information is needed for your treatment.
You also have the right to terminate a request for restriction that we have granted. You may do this by calling or writing us. We also have the right to terminate the restriction if you agree to it or if we inform you in writing that we are terminating it. If we do this, it will only apply to medical information that we create or receive after we have informed you.
Your request for a restriction must be in writing and provide us with specific information needed to fulfill your request. This would include the information you wish to be restricted and to whom you want the limits to apply.
Right to Inspect and Copy
You and your personal representative have the right to review or obtain copies of your PHI that may be used to make decisions about you. This includes medical records and billing records. It does not include the following: psychotherapy notes, information to be used in a lawsuit or administrative proceedings, and certain information subject to a law concerning laboratory improvements. Your request must be in writing and provide us with specific information needed to fulfill your request. If you call Member Services at 1-888-563-2250 or TDD for the hearing impaired at 1-888-877-5378, we will send you a form to use to do this. Or if you prefer, you may send your written request to our Member Services Department at the address listed in the "Complaints" section of this Notice. If you request copies, we can charge a reasonable fee for the cost of producing the copies and postage. You must pay this fee before we give you the copies. You may also request that we provide you with summary information about your PHI instead of all the information. If so, you must pay us the cost of preparing this summary information before we give it to you.
In certain situations, we may deny your request to inspect or obtain a copy of your PHI. If we deny your request, we will notify you in writing with the specific reason(s) the request was denied. Our letter to you will also include information about how you may request a review of our denial if you are entitled to such a review. You are entitled to request a review of our denial in three instances only. These three instances involve situations where a licensed health care professional has determined that such access would endanger the life or physical safety of you or of another person. Our letter will also tell you about any other rights you have to file a complaint. These are the same rights described in this Notice.
Right to Request an Amendment
You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why the information should be amended. Your request should be sent to our Member Services Department at the address listed in the "Complaints" section of this Notice.
We will deny your request if you fail to submit it in writing or if you fail to include the reasons for your request. We may also deny your request if you ask us to amend information that is (1) accurate and complete; (2) not part of our records; (3) not allowed to be disclosed; or (4) not created by WHA.
If we deny your request, we will provide you a written explanation. This letter will tell you how you can file a complaint with us or with the Secretary of the Department of Health and Human Services. It will also tell you about the right you have to file a statement disagreeing with our denial and other rights you may have.
If we accept your request to amend the information, we will make the changes requested in your amendment. But first we will contact you to identify the persons you want notified and to get your approval for us to do so. We will make reasonable efforts to inform others of the amendment and to include the changes in any future disclosures of that information.
Right to Receive Confidential Communications
You have the right to request that we communicate with you in confidence about your PHI by alternative means or to an alternative location (e.g. mail to a post office box address or fax to a designated number, or by phone at a number you give us). Your request must be made in writing and must clearly state that if the request is not granted it could endanger the member. WHA will accommodate reasonable requests.
Right to Receive an Accounting of Disclosures
You and your personal representative have the right to receive an accounting of disclosures regarding your health information. Typically the accounting would include disclosures found in the section titled "Other Permitted Uses and Disclosures" of this Notice. The accounting will not cover those disclosures made for the purposes of treatment, payment, and health care operations, and ones that you have authorized.
All requests for an accounting must be in writing and include specific information needed to fulfill your request. This accounting requirement applies for six years from the date of the disclosure, beginning with disclosures occurring after April 14, 2003, unless you request a lesser period of time. If you request this accounting more than once in a 12-month period, we may charge you a reasonable fee to produce the accounting of disclosures. Before doing so, we will notify you of the fee, and give you an opportunity to withdraw or limit your request in order to reduce the fee.
****** IMPORTANT ******
WHA DOES NOT HAVE COMPLETE COPIES OF YOUR MEDICAL RECORDS. IF YOU WANT TO LOOK AT, GET A COPY OF, OR CHANGE YOUR MEDICAL RECORDS, PLEASE CONTACT YOUR DOCTOR OR MEDICAL GROUP.
Right to Copies of this Notice
You have the right to receive an additional copy of this Notice at any time. You can also find this notice on our website at: www.westernhealth.com.
How to Complain about Our Privacy Practices
If you believe WHA has violated your privacy rights, or you disagree with a decision we made about access to your health information, you may contact us or the Department of Health and Human Services (DHHS) to make a complaint. We will not retaliate in any way if you choose to file a complaint with us or DHHS. Filing a complaint will not affect your benefits under WHA or Medicare.
Complaints to WHA
If you want to file a complaint with us, you can call or write to:
Western Health AdvantageAttention: Privacy Complaints2349 Gateway Oaks Drive, Suite 100Sacramento, CA 95833(916) 563-3180Complaints to the Federal Government
You also have the right to file a complaint with the federal government. You can write to:
Director, Office of Civil RightsU.S. Department of Health and Human Services200 Independence Avenue, S.W. Room 506FWashington, D.C. 20201Complaints to Medi-Cal
If you are a member of Western Health Advantage Community Health Plan through the Medi-Cal program, you have the right to file a complaint by writing to:
Privacy Officerc/o Office of Legal AffairsCalifornia Department of Health Care ServicesPO Box 997413, MS 0011Sacramento, CA 95899-7413Telephone: (916) 440-7750Email: privacyofficer@DHCS.ca.govHow to Obtain Additional Information about This Notice
If you have any questions about our privacy practices or would like an additional copy of the Notice, please contact Member Services at 1-888-563-2250, TTY 1-888-877-5378.
Changes to this Notice
The terms of this Notice apply to all records containing your health information that are created or retained by WHA. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to the Notice will be effective for all of your records that we have created or maintained in the past. Such revision or amendment shall also be effective for any of your records that we may create or maintain in the future. If we do revise this Notice you will receive a copy and the new notice will be posted on our website at: www.westernhealth.com.
Questions
If you have any questions about this notice or want further information, please contact us at WHA Privacy Officer, Western Health Advantage, 2349 Gateway Oaks Drive, Suite 100, Sacramento CA 95833, or call us at (916) 563-2250.
Effective Date of this Notice
This Notice is effective April 14, 2003 and remains in effect until changed.