Notice Of Privacy Practices

• How We Use or Share Information
• What Are Your Rights
• Exercising Your Rights

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. At Providence Health Plans we respect the privacy and confidentiality of your protected health information. We are sincere in our promise to ensure the confidentiality of your information in a responsible and professional manner. We also are required by law to maintain the privacy of your protected health information, provide you with this notice and abide by the terms of this notice. Should any of our privacy practices change, we reserve the right to change the terms of this notice and to make the new notice effective for all protected health information we maintain. Once revised, we will notify you that a change has been made and post the notice on our Web site. You may also request the new notice be mailed to you. This notice explains how we use information about you and when we can share that information with others. It also informs you about your rights as our valued customer. Finally, this notice provides you with information about exercising these rights.

We use protected health information and may share it with others as part of your treatment, payment for your treatment, and our business operations. The following are ways we may use or share information about you:

• We will use the information to administer your plan benefits and help pay your medical bills that have been submitted to us by doctors and hospitals for payment.
• We may share your information with your doctors or hospitals to help them provide medical care to you. For example, if you are in the hospital, we may give them access to any medical records sent to us by your doctor.
• We may use or share your information with others to help manage your health care. For example, we might talk to your doctor to suggest a disease management or wellness program that could help improve your health.
• We may share your information with individuals who perform business functions for us. We will only share your information if there is a business need to do so and if our business partner agrees to protect the information.
• To give you information about alternative medical treatments and programs or about health related products and services that you may be interested in. For example, we sometimes send out newsletters that let you know about “healthy living” alternatives such as smoking cessation or weight loss programs.

There are also state and federal laws that may require us to release your health information to others. We may be required to provide information to others for the following reasons:

• We may have to give information to law enforcement agencies. For example, we are required to report when we believe there has been child abuse or neglect or domestic violence.
• We may be required by a court or administrative agency to provide information because of a search warrant or subpoena.
• We may report health information to public health agencies if we believe there is a serious health or safety threat.
• We may report health information on job-related injuries because of requirements of your state worker compensation laws.
• We may report information to the Food and Drug Administration. They are responsible for investigation or tracking of prescription drug and medical device problems.
• We may have to report information to state and federal agencies who regulate us, such as the U.S. Department of Health and Human Services, Oregon Insurance Division and the Washington Office of Insurance Commissioner.

If we use or disclose your information for any reasons other than the above, we will first get your written permission. If you give us written permission and change your mind you may revoke your written permission at any time. We will honor the revocation except to the extent that we have already relied on your permission.

NOTE: If we disclose information as a result of your written permission it may be re-disclosed by the receiving party and may no longer be protected by state and federal privacy rules. However, federal or state law may restrict re-disclosure of additional information such as HIV/AIDS information, mental health information, genetic information and drug/alcohol diagnosis, treatment or referral information.

You have certain rights with respect to your protected health information. These include:

• You have the right to ask us to restrict how we use or disclose your information for treatment, payment, or health care operations. You also have the right to ask us to restrict information we may give to persons involved in your care. While we may honor your request for restrictions, we are not required to agree to these restrictions.
• You have the right to submit special instructions to us regarding how we send plan information to you that contains protected health information. For example, you may request that we send your information by a specific means (for example, U.S. mail only) or to a specified address. We will accommodate reasonable requests by you as explained above. We may require that you make your request in writing.
• You have the right to inspect and obtain a copy of information that we maintain about you in a designated record set. However, you may not be permitted to inspect or obtain a copy of information that is:
  • Contained in psychotherapy notes;
  • Compiled in reasonable anticipation of, or for use in a civil criminal or administrative action or proceeding; and
  • Subject to the Clinical Laboratory Improvements Amendments of 1988, 42 U.S.C. 263a, to the extent the provisions of access to the individual would be prohibited by law or exempt from the Clinical Laboratory Improvements Amendments of 1988, pursuant to 42 CFR 493.3(a)(2).

Additionally, in certain other situations, we may deny your request to inspect or obtain a copy of your information. If we deny your request, we will notify you in writing and will provide you with a right to have the denial reviewed.

We may require that your request be made in writing. We will respond to your request no later then 30 days after we receive it. If the information you request is not maintained or accessible to us on-site, we will respond to your request no later than 60 days after we receive it. If we need additional time, we will inform you of the reasons for the delay and the date that we will be able to complete action on your request.

If you request a copy, we will charge you a reasonable fee based on copying and postage costs. You may request a copy of the portion of your enrollment and claim record related to an appeal or grievance free of charge.

• You have the right to ask us to amend information we maintain about you in a designated record set. We may require that your request be in writing and that you provide a reason for your request. We will respond to your request no later than 60 days after we receive it. If we are unable to act within 60 days, we may extend that time by no more than an additional 30 days. If we need to extend this time, we will notify you of the delay and the date by which we will complete action on your request.

If we make the amendment, we will notify you that it was made, and we will obtain your agreement to have us notify the relevant persons you have identified with whom the amendment needs to be shared. We will notify these persons, including their business associates, of the amendment.

If we deny your request to amend, we will notify you in writing of the reason for the denial. The denial will explain your right to file a written statement of disagreement.

We have a right to rebut your statement. However, you have the right to request that your written request, our written denial and your statement of disagreement be included with your information for any future disclosures.;

• You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request. The accounting may not include disclosures:
  • For treatment, payment, and health care operations purposes;
  • Made to you;
  • Made in connection with a use or disclosure otherwise permitted;
  • Made pursuant to your authorization;
  • For a facility's directory or to persons involved in your care or other notification purposes;
  • For national security or intelligence purposes;
  • To correctional institutions, law enforcement officials;
  • Made as part of a limited data set for research, public health, or health care operations purposes; or
  • Prior to April 14, 2003.

Additionally, if we disclosed your information for research purposes pursuant to a waiver of authorization, we may not account for each disclosure of your information. Instead, we will provide for you: (1) the name of the research protocol or activity; (2) a description of the research protocol or activity including the purpose for the research and the criteria for selecting particular records (3) a description of the type of protected health information that was disclosed; (4) the date or period of time when such disclosure occurred; and (5) the name, address, and telephone number of the entity that sponsored the research and researcher to whom the information was disclosed.

We will act on your request for an accounting within 60 days. We may need additional time to act on your request, and therefore may take up to an additional 30 days. Your first accounting will be free, and we will continue to provide to you one free accounting upon request every 12 months. However, if you request an additional accounting within 12 months of receiving your free accounting, we may charge you a fee. We will inform you in advance of the fee and provide you with an opportunity to withdraw or modify your request.

You have a right to receive a paper copy of this notice upon request at any time.

If you have any questions about this notice or our privacy practices, please contact Customer Service at503-574-7500 or toll free at 1-800-878-4445. For TTY (telecommunication services for the hearing impaired), please call 503-574-8702 or 1-888-244-6642. Our office is open Monday through Friday from9 a.m. to 5 p.m.

You also can send us general privacy questions online, however this service is currently unavailable for Medicare members.

If you believe your privacy rights have been violated, you may file a complaint with us by writing Appeals & Grievances at:

Providence Health Plan

Attn: Appeals and Grievance Dept.
P.O. Box 4327
Portland, OR 97208-4327

You may also notify the Office of Civil Rights, U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint. You may contact the Office of Civil Rights at:

Office for Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: 1-800-368-1019
E-mail: ocrmail@hhs.gov
Web site: Office For Civil Rights

For more information about uses and disclosers of member information, including uses and disclosures required by law, please refer to our Notice of Privacy Practices.