Notice of Privacy Practices
This notice describes how medical information about you may be used
and shared and how you can get access to this information. Please review it carefully.
Health Choice Insurance Co. (Health Choice) is a Qualified Health Plan offered through
the federal Health Insurance Marketplace.
We are required by law to maintain the privacy of your medical information. This
notice describes how we handle your medical information and protect that information.
This notice also explains your rights about your medical information. Please review
this Notice carefully.
How We May Use and Disclose Medical Information About You:
For Treatment - We may use medical information about you to provide
you with medical
treatment or services. We may disclose medical information about you to doctors,
nurses, or other hospital personnel involved in taking care of you. We also may
disclose medical information about you to people outside of the Health Choice who
may be involved in your medical care, such as family members or others who provide
services that are part of your care.
For Payment - We may use and disclose medical information about
you so that providers from whom you receive treatment and services may receive payment.
Examples of payment activities include: billing, claims management and other related
administrative functions.
For Health Care Operations - We may use and disclose medical information
about you for our health care operations. These uses and disclosures are necessary
to run Health Choice and make sure that you and others we cover receive quality
care. For example, we may use medical information to review the treatment and services
rendered by a provider to evaluate the provider’s performance.
When Required By Law - We will share medical information about
you when federal, state, or local requires us to do so. For example, we are required
to report these items, when applicable:
- Work related injuries to workers compensation;
- Suspected fraud, waste or abuse;
- Information about immunizations and lead blood levels; and
- Information in connection to a Federal investigation to protect our country, the
President and other government workers.
To prevent a Serious Threat to Health or Safety - We may use and
disclose medical
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. Any disclosure
would be limited to disclosure to someone able to help prevent the threat.
Health oversight activities - We may share medical information
with the Arizona
Department of Insurance or another health oversight agency for activities authorized
by law. This could include audits, investigations, and inspections to review the
health care system and how you get health care.
Health-related benefits or services - From time to time, we may
use and share your
medical information so that we may to tell you about benefits or services available
to you. This may include communications about our various health‑related
products or services, such as our AHCCCS health plan or our Medicare Advantage Special
Needs Plan with prescription drug coverage (MA-PD), for which you may be eligible.
Lawsuits and disputes - If you are involved in a lawsuit or a grievance,
we may
share medical information about you to respond to a court order or an administrative
order. We may also share medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else involved in the dispute.
Law enforcement - We may release medical information if asked to
do so by a law
enforcement official:
- As required by law;
- In response to a court order, subpoena, warrant, summons, administrative request
or similar process; and/or
- In emergency circumstances to
report a crime; the location of the crime or victims; or the identity,
description or location of the person who committed the crime.
When
Your Written Permission (Authorization) Is Required
for Other Uses and Disclosures
We
will obtain your written permission prior to the use or disclosure of your
medical information anytime the law does not allow us do so without your
permission and for a purpose other than listed above. For example, the law requires us
to get your
permission for the following types of medical information and purposes:
- Psychotherapy notes and genetic testing information - If we hold these notes or
testing information, we will those notes or that information to others only if we
have your permission;
- HIV testing information - If we hold HIV-related information about you, we will
give that information to others only if we have your permission or if we are required
by law to give out that information;
- Substance abuse information – If
we hold this information, we will only disclose information identifying you as
being a substance abuse patient or provide any medical information relating to
your substance abuse treatment if (i) you give us
your permission to do so in writing; (ii) a court order requires disclosure of
the information; (iii) medical personnel need the information to meet a medical
emergency; (iv) qualified personnel use the information for the purpose of
conducting scientific research, management audits, financial audits, or program
evaluation; or (v) it is necessary to report a crime of a threat to commit a
crime, or to report abuse or neglect as required by law;
- For marketing purposes; and
- For the sale of your medical
information.
If
you provide us with written permission to use or disclose medical information
about you, you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. We are unable
to protect information that has already been disclosed with your permission.
Your Rights Regarding
Your Medical Information:
Right to look at and copy your medical
information - You have the right to look at and
copy medical information that may be used to make decisions about your medical
care, including the review of treatment requests and claims from your doctors.
Usually, this includes a paper or electronic copy of your records and/or bills
that providers send to us. If you want to ask us for a copy, write to our
Privacy Officer at the address at the end of this Notice. We may charge you a
fee for our postage and labor costs and supplies to create the copy. There may be times
when we may deny your
request to look at or copy your medical information. If that happens, you have
a right to submit a request in writing and ask us to review our decision to
deny your request.
Right to amend your medical information - If you feel that your
medical information
created by
Health Choice is incorrect or incomplete, you can ask us to change that
information. To ask us to change your
information, write to our Privacy Officer at the address at the end of this
Notice. Please tell us clearly what you information you want to change. We may deny your
request for any of the
following reasons:
- Submitted by phone rather than in
writing;
- Missing the reason(s) to support
the request; and/or
- Medical information that is the
subject of the request was not created by Health Choice.
For
any medical information created by your health care provider (i.e., doctor,
hospital, clinic, etc.), please send a request to change your information to
that individual or entity directly.
Right to request restrictions - You have the right to ask us to
restrict or limit
how we use or disclose your medical information for treatment, payment, or
operations. For example, you may ask us
not to disclose that you have had a particular surgery or treatment. You may
also ask that we restrict the disclosure of your medical information to your
relatives or friends that are involved with your care. To ask us to restrict
your information, write to our Privacy Officer at the address at the end of
this Notice. Please tell us: what information you want to limit; whether you
want to limit its use, disclosure, or both; and to whom you want the limits to
apply.
We
are not required to agree to your request, except for requests to restrict
disclosures to us for purposes of payment or health care operations when you
have paid in full out-of-pocket for an item or service covered by the request
and when the disclosure is not required by law. If we agree, we will comply
with your request unless the information is needed to provide you with
emergency treatment.
Right to private communications - You have the right to ask us
to communicate with
you
only in writing or at a certain address or phone number if you think the normal
way we communicate will be dangerous to you.
To ask us for private communication, write to our Privacy Officer at the
address at the end of this Notice. Please tell us: how our normal way of
communicating with you is dangerous to you; how or where you wish to be
contacted; and what information is to be communicated in this manner.
Right to accounting of disclosures - You have a right to ask us
for a list of people
or
groups to whom we have disclosed your medical information. This is called an
accounting of disclosures and includes the dates your medical information was
disclosed, the reasons for the disclosures and the types of medical information
disclosed. To ask us for a list, write to our Privacy Officer at the address at
the end of this Notice. Tell us the period of time for which you want a list of
disclosures. The list will not include:
disclosures we made to you, those we made with your permission or those we made
for our treatment, payment or operations activities.
Right to a Paper Copy of this Notice - You have the right to a
paper copy of this
Notice.
To ask us for a paper copy, write to our Privacy Officer at the address at the
end of this Notice or contact our Member Services Department at (855)452-4242
(Mon-Fri 6AM to 6PM except on holidays).
If you have trouble hearing, call TTY/TDD: 711. This notice is available online at:
www.healthchoiceessential.com.
We
may change this Notice. The changes to
the Notice might involve medical information we already have about you, as well
as any information we get in the future. If we do change the Notice, we will
provide you with the new Notice by posting it online at the above web address
or mailing it to you, upon request. You
will always know which one is the most current because we print the effective
date of the Notice on the top of the front page. We are required to abide by
the terms of the Notice currently in effect.
Other obligations:
Breaches - We are required by law to notify affected
individuals following a breach of unsecured medical information.
Complaints - You have the right to file a complaint if you
believe your privacy rights have been violated.
To file a complaint, write to our Privacy Officer at the address at the
end of this Notice. You may also file a
complaint with the Secretary of the Department of Health and Human Services.
You will not be penalized or discriminated against for filing a complaint.
Questions - If you have any questions about this notice,
contact our Privacy Officer. Your medical treatment providers (i.e., doctors,
hospitals, home health agencies, etc.) may have different policies or notices
about the use and sharing of your medical information. If you have questions
about your provider's privacy policies, please contact your provider directly.
How
to contact our Privacy Officer: Write to - Health Choice Privacy Officer / 410
N. 44th Street, Ste. 900 / Phoenix, AZ 85008.
Or call us at: (855)452-4242 (Mon-Fri 6AM to 6PM except on holidays). If you have trouble
hearing, call TTY/TDD:
711.
Puede obtener una copia de este formulario en español, si la pide.
(Effective Date September 23, 2013)