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Privacy Practices
NOTICE OF PRIVACY PRACTICE AT OPTIMUM HEALTHCARE
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 Effective 1/1/2006
OUR COMMITMENT REGARDING YOUR PROTECTED HEALTH INFORMATION We understand the importance of Your Protected Health Information (hereafter referred to as “PHI”) and follow strict polices (in accordance with state and federal privacy laws) to keep your PHI private. PHI is information about you, including demographic data, that can reasonably be
used to identify you and that relates to your past, present or future physical or mental health, the
provision of health care to you or the payment for that care. Our policies cover protection of your
PHI whether oral, written or electronic.
This notice informs you of the ways we may use and disclose your health information. It also notifies you of your rights and our obligations in our use and disclosure of your health information. We are required to give you this notice. You have the right to request additional copies of this notice at any time by contacting the Privacy Officer identified below. We must abide by the terms of the notice, currently in effect.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided that applicable law permits such changes. These revised practices will apply to your PHI regardless of when it was created or received. If we make a material change to our privacy practices, we will provide a revised notice to you by mail.
OUR USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We do not sell your PHI to anyone.
We must have your written authorization to use and disclose your PHI, except for the following uses and disclosures:
• For Treatment: We may use and disclose your PHI to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment. For example, we may disclose your PHI to health care providers in connection with disease and case management programs.
• For Payment: We may use and disclose your PHI for our payment-related activities and those of health care providers and other health plans, including for example:
- Obtaining premiums and determining eligibility for benefits
- Paying claims for health care services that are covered by your health plan
- Responding to inquiries, appeals and grievances
- Coordinating benefits with other insurance you may have
• For Health Care Operations: We may use and disclose your PHI for our health care operations, including for example:
- Conducting quality assessment and improvement activities, including peer review, credentialing of providers and accreditation
- Performing outcome assessments and health claims analyses
- Preventing, detecting and investigating fraud and abuse
- Underwriting, rating and reinsurance activities
- Coordinating case and disease management activities
- Communicating with you about treatment alternatives or other health- related benefits and services
- Performing business management and other general administrative activities, including systems management and customer service
We may also disclose your PHI to other providers and health plans who have a relationship with you for certain of their health care operations. For example, we may disclose your PHI for their quality assessment improvement activities or for health care fraud and abuse detection.
• To Others Involved in Your Care: We may under certain circumstances disclose to a member of your family, a relative, a close friend or any other person you identify, the PHI directly relevant to that person’s involvement in your health care or payment for health care. For example, we may discuss a claim determination with you in the presence of a friend or relative, unless you object.
• When Required by Law: We will use and disclose your PHI if we are required to do so by law. For example, we will use and disclose your PHI in responding to court and administrative orders and subpoenas, and to comply with workers’ compensation laws. We will disclose your PHI when required by the Secretary of Health and Human Services and state regulatory authorities.
• For Matters in the Public Interest: We may use or disclose your PHI without your written permission for matters in the public interest, including for example:
- Public health and safety activities, including disease and vital statistic reporting, child abuse reporting, and Food and Drug Administration oversight
- Reporting adult abuse, neglect, or domestic violence
- Reporting to organ procurement and tissue donation organizations
- Averting a serious threat to the health or safety of others
• For Research: We may use your PHI to perform select research activities, provided that certain established measures to protect your privacy are in place.
• To Our Business Associates: From time to time we engage third parties to provide various services for us. Whenever an arrangement with such a third party involves the use or disclosure of your PHI, we will have a written contract with that third party designed to protect the privacy of your PHI. For example, we may share your information with business associates who process claims or conduct disease management programs on our behalf.
• Partially De-Identified Information. We may use and disclose “partially de-identified” health information about you for public health and research purposes, or for business operations, if the person who will receive the information signs an agreement to protect the privacy of the information as required by federal and state law. Partially de-identified health information will not contain any information that would directly identify you (such as your name, street address, Social Security number, phone number, fax number, electronic mail address, Web site address, or license number)
• Other Uses and Disclosures: Uses and Disclosures for purposes, other than those listed above will be made only with our written authorization. You may submit a request to revoke an authorization at any time. We require your revocation to be submitted in writing. Although you are not required to complete the Authorization Form, one may be provided to you. To obtain the form, call the customer service number on the back of your membership card or visit our website at: www.freedomhealth.com.
INDIVIDUAL RIGHTS
• Your Right to Access: With limited exceptions, you have the right to review or obtain copies of your PHI. We may charge you a reasonable fee as allowed by law, for copies of your PHI. To exercise you right, please call member services at the number on the back of your membership card. In some, cases we may require your authorization to be submitted in writing. To obtain a standard Authorization form, call the customer service number on the back of your membership card or visit our website at: www.freedomhealth.com.
• Your Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of certain disclosures of your health information that we have made. To request this list of disclosures, you must submit a written request to the privacy officer. Your request must state a time period for which the accounting is requested. The time period may not be longer than six years and may not include dates before your enrollment effective date with Optimum HealthCare. You may receive one list per year without charge. We may charge you for the costs of providing additional lists within one year after your first request. We will notify you of the cost involved and you may choose to withdraw or modify your request if you do not wish to pay the cost.
• Your Right to restrict our Activities: You have the right to request that we restrict the use or disclosure of your health information for treatment, payment, or healthcare operations (as described above). We are not required to agree to your request. The Health Plan may require you submit your request for restrictions in writing to the Privacy Officer. In your written request, you must tell us (1) what information you want to limit;
(2) whether you want to limit use of the information and/or disclosure of the information; and (3) to whom the limitations or restrictions will apply. The Privacy Officer will notify you in writing whether we have agreed to your request or not, with an explanation for the decision.
• Your Right to Amendment: You have the right to request that we amend or correct your PHI. The Health Plan may require you submit your request for amendment or correction in writing, including a reason to support the requested amendment. If we deny your request, we will provide you a written explanation. If you disagree, you may have a statement of your disagreement placed in our records. If we accept your request to amend the information, we will make reasonable efforts to inform others, including individuals you name, of the amendment.
• Your Right to Request Confidential Communications: You have the right to tell us how you would like us to communicate with you. For example, you may ask that we call you at a certain phone number, or you may tell us whether we may leave a message for you. To request confidential communications, you must make your request in writing to the Privacy Officer listed below. Your request must specify how or where you wish to be contacted. We will follow all reasonable requests for confidential communications.
• Your Right to Request and Receive Privacy Notice: You have the right to request and receive a copy of this notice at any time. If you have agreed to receive the notice electronically, we will provide a paper copy of the notice upon request.
• Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer. You may also file a complaint with the Office for Civil Rights (OCR). We encourage your feedback regarding our privacy policies, and we will not retaliate against you in anyway if you file a complaint.
o For your convenience, you may also obtain an electronic (downloadable) copy of this notice online at www.freedomhealth.com
o If you are concerned that we may have violated your privacy rights, or you believe that we have inappropriately used or disclosed your PHI, call us at (800) 548-0094. You may remain anonymous if you choose. All information received is considered confidential and protected from retaliation. You may also download and complete our Authorization form from our website (www.youroptimumhealthcare.com). Submit your form to:
Mailing Address: Optimum Healthcare, Inc. Privacy Officer
P.O. Box 151137
Tampa, FL 33684
Fax: 1-888-548-0092
Email: ComplianceReporting@americas1stchoice.com
CONTACT INFORMATION:
For questions regarding this notice, or to receive further information, please contact Optimum Healthcare’s Privacy Officer at:
Optimum Healthcare
Pawan Shah, Privacy Officer
P.O. Box 151137
Tampa, FL 33684
1-866-245-5360
Board of Directors (Information for use by the Board of Directors of Optimum HealthCare, Inc. Log in required.)
