Notice of Privacy Practices

April 1, 2006

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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 Peach State Health Plan your privacy is important. We will do all we can to protect your health records. By law, we must protect your health records and send you this notice.

This notice tells you how we use your health records. It describes when we can share your records with others. It explains your rights about the use of your health records. It also tells you how to use those rights and who can see your health records. This notice does not apply to records that do not identify you.

When we talk about your health records in this notice, it means any record of your health services while you are a member of Peach State Health Plan. This includes providing healthcare to you. It also includes payment for your care while you are our member.

Please note: You will also receive a Privacy Notice from the State of Georgia with its rules for your health records. Other health plans and providers may have other rules when using or sharing your health records. We ask that you get a copy of their Privacy Notices and read them.

HOW WE USE OR SHARE YOUR HEALTH RECORDS

Here are ways we may use or share your health records:

  • To help us pay the bills your providers send us.
  • To help your providers give you proper care. If you are in the hospital, we may give the hospital the records your doctor sends us.
  • To help manage your health. We might talk to your doctor about a disease or wellness program that could improve your health.
  • To help resolve any administrative reviews or grievances filed by you or a provider with Peach State Health Plan or the State of Georgia.
  • To assist others who help us provide your health services. We will not share your records with these groups unless they agree to protect your records.
  • For public health or disaster relief efforts.
  • To remind you if you have a doctor’s visit.
  • To tell you about other treatments and programs. This could be on how to stop smoking or lose weight.
  • To design special health programs and services
  • State and federal laws may call for us to give your health records to others. This could be for these reasons:
  • To state and federal agencies that control us. These agencies include the Georgia Department of Job and Family Services.
  • For public health actions. For example, the Food and Drug Administration may need to check or track medicines. Or it may need to track medical device problems.
  • To public health groups. This may be done if we think a serious public health or safety threat exists.
  • To a health agency for certain activities. These activities may be audits and inspections. Sometimes they are licensure and disciplinary actions.
  • To a court or administrative agency.
  • To law enforcement. For example, we may give your records to a law enforcement officer to find someone. This person could be a suspect or fugitive. Or someone who is missing or a material witness.
  • To a government person. This could be about child abuse. Or it could be about neglect or violence in your home.
  • To a coroner or medical examiner to name a dead person. Or to find the cause of death. Or to funeral directors to help with their duties.
  • For organ transplant purposes.
  • For special government roles. This could be military and veteran events. Or national security and intelligence actions. Or it could be to protect the President and others.
  • About injuries on the job due to worker compensation laws.

If one of the above reasons does not apply, we must get your written approval. This approval asks if you will let us use or share your records with others. If you change your mind, let us know. We will stop it.

If sharing your health information is not allowed by or limited by a state law, we will obey the law that better protects your health information.

WHAT ARE YOUR RIGHTS?

The following are your rights about your health records. If you would like to use any of these rights, please contact us. We can be reached at 1-800-704-1484.

  • You have the right to ask us to give your records only to certain people or groups. And you have the right to say for what reasons. You also have the right to ask us to stop your records from being given to family members. You have the right to ask us to stop your records from being given to others involved in your care. While we try to honor your wishes, the law does not make us.
  • You have the right to ask for a private exchange of your records. If you believe that you would be harmed if we mailed your records to your home address, you can ask us to send them by other means. Other means might be fax or mailed to another address.
  • You have the right to view and get a copy of all the records we keep about you. This is anything we use to make decisions about your health. It includes enrollment and payment. It also includes claims and medical management records.
  • You do not have the right to get certain types of health records. We may decide not to give you these:
    • Records that have psychotherapy notes.
    • Records collected for use in a court case or other legal action.
    • Records subject to federal laws about biological products and clinical laboratories.
  • In some cases, we may not let you get a copy of your records. You will be informed in writing. You may have the right to have our action reviewed.
    • You have the right to ask us to make changes to wrong or incomplete records.These changes are known as amendments. You must ask for the change in writing. You need to give a reason for your change(s). We will get back to you in writing no later than 60 days after we receive your letter.
    • If we need more time, we may take up to another 30 days. We will inform you of any delays and tell you when we will get back to you. If we make your changes, we will let you know they were made. We will also give your changes to others who we know have your records and to other persons you name.
    • If we choose not to make your changes, we will let you know why in writing. You will have a right to send us a letter disagreeing with us. We have a right to answer your letter. You then have the right to ask that your original request for changes, our denial and your second letter disagreeing with us be put with your records.
  • You have the right to receive a list of when we have given your records to others during the past six years. By law, we do not have to give you a list of the following:
    • Any records collected prior to January 1, 2006.
    • Records given or used for treatment, payment and healthcare operations purposes.
    • Records given to you or others with your written approval.
    • Records that are incidental to a use or disclosure otherwise permitted.
    • Records given to persons involved in your care or for other notification purposes.
    • Records used for national security or intelligence purposes.
    • Records given to prisons or police. Or to FBI and others who enforce laws.
    • Records given to health oversight agencies.
    • Records given or used as part of a data set for research. Or for public health or healthcare operations purposes

Your request must be in writing. We will act on your request within 60 days. If we need more time, we may take up to another 30 days. Your first list will be free. We will give you one free list every 12 months. If you ask for another list within 12 months, we may charge you a fee. We will tell you the fee first and give you a chance to take back your request.

USING YOUR RIGHTS

  • You have a right to get a copy of this notice at any time. We have the right to change the terms of this notice.Any changes in our privacy practices will apply to all the health records we keep. If we make changes, we will send you a new notice.
  • If you have any questions about this notice or how we use or share your health records, please call.We can be reached at 1-800-704-1484. That office is open Monday through Friday from 9:00 a.m. to 5:00 p.m.

If you believe your rights have been broken, you may file a complaint in writing to:

Privacy Official
Peach State Health Plan
3200 Highlands Parkway SE
Suite 300
Smyrna, GA 30082
1-800-704-1484

You may also contact the Secretary of the United States, Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health & Human Services
61 Forsyth Street, SW. – Suite 3B70
Atlanta, GA 30323
(404) 562-7886
(404) 331-2867 (TDD)
(404) 562-7881 FAX
www.hhs.gov/ocr