Notice of Privacy Practices

 

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 Plan, 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 are required by law to maintain the privacy of your protected health information, provide you with this notice, abide by the terms of this notice, and to notify you if a breach of your unsecured protected health information occurs. 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 website. You also may request the new notice be mailed to you.

This Notice also describes the privacy practices of an Organized Health Care Arrangement ("OHCA") between us and certain eligible healthcare providers and organizations. An OHCA allows legally separate covered entities to use and disclose PHI for the joint operation of the arrangement. We may participate in such an arrangement of health care organizations who have agreed to work with each other to facilitate access to health information relevant to your care. For example, Providence Health Plans and the covered entities within Providence Health & Services have agreed, as permitted by law, to share your health information. Providence Health & Services covered entities are separate health care providers and each is individually responsible for its own activities, including compliance with privacy laws, and all health care services it provides. For information about organizations that may participate in our OHCA, please contact the Privacy phone number providedin this Notice.

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.

How we share your information:

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

  • Payment: We will use the information to administer your plan benefits, including but not limited to making claims determinations and coordinating your benefits with other coverage you may have. We will use the information to help pay your medical bills that have been submitted to us by doctors and hospitals for payment. We may also use and disclose personal information to collect premiums, calculate cost-sharing amounts, respond to complaints, appeals and requests for external review. We may share your information to the sponsor of your plan if requested so that the sponsor can obtain premium bids or modify, amend, or terminate the plan.
  • Treatment: 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.
  • Health Care Operations: We may use and disclose personal information during the course of running our health business - that is, during operational activities such as quality assessment and improvement, performance measurement and outcomes assessment; health services research; and preventative health, disease management, case management and care coordination. We may use your 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. Other operational activities requiring use and disclosure of health information include underwriting and rating; detection and investigation of fraud; administration of pharmaceutical programs and payments; and other general administrative activities, including data and information systems management, and customer service. If we use or disclose health information for underwriting purposes, we are prohibited from using or disclosing health information that is genetic information of an individual for such purposes. 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.

State and federal laws may require us to release your health 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 an act of 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 that regulate us, such as the U.S. Department of Health and Human Services, Oregon Insurance Division and the Washington Office of Insurance Commissioner.

Uses and Disclosures Requiring Your Written Authorization

If we use or disclose your information for any reasons other than the above, we will first get your written permission. For example, we will get your authorization:

  • For marketing purposes that are unrelated to your benefit plan(s);
  • Before most disclosures of psychotherapy notes (exceptions exist such as disclosures required by law or disclosures in the defense of a legal proceeding brought by you);
  • Related to the sale of your health information;
  • For other reasons as required by law;

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.

What are your rights?

You have certain rights with respect to your protected health information including:

  • Request to Restrict Information: 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.
  • Special Instructions Regarding Information: 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.
  • Request for Information: 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 for information be made in writing. We will respond to your request no later than 30 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, which will be no more than 30 additional days. If you request a copy, it will be provided to you in the form and format requested by you if the information is readily producible in that format. 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.
  • Request for Amendment: 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.
  • Request for Accounting: 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
    • 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.

Exercising your rights:

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 at 503-574-7500 or toll-free at 800-878-4445. For TTY (telecommunication services for the hearing impaired), please call 711. Our office is open Monday through Friday, 9 a.m. to 5 p.m. You also can send us general privacy questions online; however, this service is currently unavailable for Medicare members.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by writing:
Providence Health Plan
Attn: Appeals and Grievance Dept.
P.O. Box 4327
Portland, OR 97208-4327

You also may notify the Office for 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 for 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
Website: Office for Civil Rights

Confidentiality of Member Information:

Medical care is a deeply personal issue for people. All of us need to know that information about our health care is private and confidential. Providence Health Plan respects the privacy of our members and takes great care to determine when it is appropriate to share your personal health information. Such uses may include intervention programs that improve your medical treatment; quality measurement processes; and audit of your claims record to ensure accurate and timely payment and release of information to your primary or secondary insurance carrier to assist with coordination of benefits.

Providence Health Plan makes every effort to release only the amount of information necessary to meet any release requirement and only releases information on a need-to-know basis. Also, wherever feasible, identifiable information is removed from any information shared within and outside of Providence Health Plan.

To secure the confidentiality of medical information, Providence Health Plan has the following procedures in place:

  • Access to a member's medical information held by the plan is restricted to only those Providence employees who need this information and to the member. Entries into member records are tracked for security purposes. Employees must report any security violations.
  • Unique and secured log-in names and passwords are required to access the Providence Health Plan computer system. In addition, firewalls, encryption and data backup systems are used. Similar strategies are used for protecting confidential information on our website.
  • Providence employees are educated about privacy issues and sign a confidentiality statement upon employment, then review the information and sign again each year.
  • Each department within Providence Health Plan adopts specific policies to monitor the handling of member information.
  • Providence Health Plan uses member personal health information within Providence Health Plan to process claims, or for the purposes of disease management or quality improvement.
  • Members must sign an authorization to release identifiable member information outside of Providence Health Plan or its authorized agents, except when the law requires or permits such a release or for treatment, billing and health care operations.
  • When member information is used in health studies, identifiable information is not released. All member-specific information has identifying information removed, and aggregated data are used as early in the measurement process as possible. The privacy of Providence Health Plan members is completely protected.
  • Our agreements with participating providers contain confidentiality provisions that require these providers to treat your personal health information with the same care as Providence Health Plan.
  • You have the right to register a complaint if you believe your privacy is compromised in any manner.
  • Members may request to see their medical records. Call your physician's or provider's office to ask how to schedule a visit for this purpose.

If you have questions about your own medical information or those of another member of your household, please contact your Customer Service Team. If you have further questions about Providence Health Plan’s privacy practices, please call (503) 574-7770.

Website Disclaimer:

Providence Health Plan maintains this website as a health information resource for educational and informational purposes. It is not provided as a professional service or as medical advice for specific conditions, but rather provides general information about certain health and medical conditions. It is not a substitute for professional medical advice. If you have, or suspect you may have, a health condition, you should consult your health care provider for specific medical advice.

This website provides links to other health care resources that we make available simply as a convenience to our users. We do not control or endorse any such other sites, or any products or services sold on such other sites, and disclaim any responsibility for the content of such third-party sites. Any reference to specific products or services on such other sites does not constitute or imply recommendation or endorsement by Providence Health Plan. Users of this site assume full responsibility for their use of the information obtained from this site, and understand and agree that Providence Health Plan is not responsible or liable for any claim, loss, or damage arising from the use of the information.

Providence Health Plan does not recommend, endorse, or promote any procedure or intervention that may be discussed on this site, and which may be prohibited by Providence Health Plan’s Mission and Core Values and the Roman Catholic moral tradition as articulated in such documents as The Ethical and Religious Directives for Catholic Health Care Services.

Effective September 2013