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.