«Partnership HealthPlan of California Medi-Cal Member Handbook Together for your Health Our Service Area Del Norte, Humboldt, Lake, Lassen, Marin, ...»
Keeps policies and procedures that tell how member information is protected As a requirement for employment, all PHC employees are required to sign a confidentiality statement and take compliance training Puts in provider contracts PHC’s expectations on privacy and confidentiality, and PCP offices are monitored by PHC to make sure they keep patient information confidential Tells providers in PHC’s network about members’ rights to access their medical records at no charge Has a committee that creates and reviews our privacy policies and practices PHC policies and procedures protect your information, no matter how we get that information (for example, by computer, over the phone or in writing). PHC employees only have access to the information they need to do their job. PHC also uses passwords, secure email software and other technology to protect sensitive information. PHC does not give out protected information to anyone, or any group that does not have a right to that information by law.
Your protected information is important to PHC because we need this information to get you the
health care you need. The type of information we use and disclose includes your:
PHC does not have complete copies of your medical records. If you need copies of your medical records you should check with your PCP or other providers that have given you health care services.
When can PHC release my information?
Unless allowed by law, PHC needs your written approval to release your information to someone. Below is a list of times we do not need your written approval to release your
A court, arbitrator or similar agency needs your information A coroner needs your health information Your health information is needed by law Your health information is needed for treatment, payment or for health care operations
We may give your health information to another health plan to:
Make a diagnosis or give treatment Make a payment for your health care Review the quality of your health care
We may also give your information to:
Groups who license health care providers for quality reasons Public agencies Investigators, like law enforcement Probate courts Organ donation groups Federal or state agencies as required by law Disease management programs Other health plans or providers involved in your care
Please note that we won’t tell anyone the results from any genetic testing.
If you have questions about your health information privacy or when PHC can release your information, call PHC’s Member Services Department at (800) 863-4155.
If you believe your privacy has not been protected, you can file a complaint with PHC’s Member Services Department at (800) 863-4155. You can also contact the Department of Health Care Services at (916) 255-5259, TTY/TDD (877) 735-2929, or the U.S. Office of Civil Rights toll free at (866) 627-7748, TTY/TDD (866) 788-4989. These numbers are available 24 hours a day, 7 days a week. All calls are confidential.
Protecting yourself from identity theft Identity theft is when someone else uses your information, illegally, to obtain health care or commit other kinds of fraud.
To protect yourself from this kind of theft, you should do the following:
Protect your PHC ID card like you protect your bank or credit cards Take your ID card to your provider’s appointment, and show your California ID (for example, a driver’s license) when you get care Try to avoid speaking about your membership information, personal information like your address or saying your social security number out loud or to people who don’t have a right to that information Don’t give out your personal information, unless it is asked for by your provider, medical group, health center, hospital, other medical staff or PHC staff If you ever think your information has been stolen, or if you lose your PHC ID card, call PHC’s Member Services Department at (800) 863-4155.
Section 15 – How you can make a difference Learn about how to participate in the policy making process at PHC.
PHC Consumer Advisory Committee (CAC) PHC has a Consumer Advisory Committee (CAC) that meets a few times during the year. The CAC has meetings in different parts of PHC’s service area, so there is a CAC meeting you can attend in your part of the State.
Here’s how you can get involved:
Attend the meetings: All PHC members and other interested parties can attend these meetings. Members can talk about their experiences in receiving medical services through PHC. They can also give input to the CAC and make suggestions for improving services.
Become a CAC Member: Several people have seats on the committee as a member. They are PHC members who live in different parts of the PHC Service Area. To find out if there is a seat available to represent where you live, call PHC’s Member Services Department at (800) 863-4155.
Other Meetings Our Commission meetings (also called Board meetings), and the Physician Advisory Committee (PAC) are open to the public. PHC posts the agenda and meeting locations at its offices in an easy to find place, right on the front door! You can attend one of these meetings at the meeting location listed on the announcement.
If you need a list of PHC meeting date, times and locations, calls PHC’s Member Services Department or visit our website at www.partnershiphp.org.
The PHC Member Newsletter PHC will send you a member newsletter. The newsletter includes health education information and healthy recipes.
If you want a copy of the most recent Newsletter, call the PHC Member Services Department or visit our website at www.partnershiphp.org.
Section 16 – Notice of Privacy Practices Learn about what PHC does with your information and 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.
Why am I receiving this Notice?
Partnership HealthPlan of California is required by law to provide you with adequate notice of the uses and disclosures of your protected health information that we may make, and of your rights and our legal duties and to notify you following a breach of your unsecured health information where your protected health information (PHI) is concerned.
We agree to follow the terms of this Notice of Privacy Practices. We also have the right to change the terms of this notice if it becomes necessary, and to make the new notice effective for all health information we maintain. If we need to make any changes, we will provide you an updated copy of this notice by mailing it to you at your address in our records. If you received this notice electronically, you have the right to request a paper copy from us at any time.
How does Partnership HealthPlan of California (PHC) use and disclose my health information?
PHC stores health-related records about you, including your claims history, health plan enrollment information, case management records, and prior authorizations for treatment you
receive. We use this information and disclose it to others for the following purposes:
Treatment. PHC uses your health information to coordinate your health care, and we disclose it to hospitals, clinics, physicians and other health care providers to enable them to provide health care services to you. For example, PHC maintains your health information in electronic form, and allows pharmacies to have on-line access to it to provide appropriate prescriptions for you.
Payment. PHC uses and discloses your health information to facilitate payment for health care services you receive, including determining your eligibility for benefits, and your provider's eligibility for payment. For example, we inform providers that you are a member of our plan, and tell them your eligible benefits.
Health care operations. PHC uses and discloses your health information as necessary to enable us to operate our health plan. For example, we use our members' claims information for conducting quality assessment and improvement activities, patient safety activities, business management and general administrative activities, and reviewing competence or qualifications of health care professionals.
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We also disclose health information to our service providers who assist us in these functions, but we obtain assurances from them that they will use appropriate safeguards to prevent use or disclosure of the information other than as outlined in our contract before we make such disclosures for payment or operational purposes. For example, companies that provide or maintain our computer services may have access to your computerized health information in the course of providing services to us.
Communication and Marketing: PHC will not use your health information for marketing purposes for which we receive payment without your prior written authorization. We may use your health information for case management or care coordination purposes and related functions without your authorization. We may provide appointment or prescription refill reminders or describe a product or service that is included in your benefit plan, such as our health provider network. We may also discuss health-related products or services available to you that add value, but are not part of your benefit plan.
Sale of your health information: We will not sell your health information for financial remuneration without your prior written authorization.
Fundraising: We may use, or disclose to a business associate or to an institutionally related foundation, for the purpose of raising funds for the benefit of PHC, certain information without your authorization for fundraising purposes, including your name, address, contact information, age, gender, date of birth, dates of health care provided, treatment of service information, treating physician, outcome information and health insurance status. However, we will provide you with a clear and conspicuous opportunity to opt out of receiving further fundraising communications in a way that does not cause you undue burden or cost, and will honor that request. We will not condition treatment or payment on your choice with respect to the receipt of fundraising communications. We may provide you with a way to opt back in to receive such communications if you later prefer.
Can my health information ever be released without my permission?
Yes, we may disclose health information without your authorization to government agencies and private individuals and organizations in a variety of circumstances in which we are required or authorized by law to do so. Certain health information may be subject to restrictions by federal or state law that may limit or prevent some uses or disclosures. For example, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, genetic information, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment. We comply with these restrictions in our use of your health information.
Examples of the types of disclosures we may be required or allowed to make without your
When Legally Required: PHC will disclose your health information when it is required to do so by any federal, state or local law When there are Risks to Public Health: PHC may disclose your health information:
To public health authorities or to other authorized persons in connection with public o health activities, such as for preventing or controlling disease, injury or disability or in the conduct of public health surveillance or investigations
In Connection with Judicial and Administrative Proceedings: PHC may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when PHC makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes:
As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena, summons or similar process For the purpose of identifying or locating a suspect, fugitive, material witness or missing person Under certain limited circumstances, when you are the victim of a crime To a law enforcement official if PHC has a suspicion that your death was the result of criminal conduct including criminal conduct at PHC In an emergency in order to report a crime To Coroners and Medical Examiners: PHC may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors: PHC may disclose your health information to funeral directors consistent with applicable law and, if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, PHC may disclose your health information prior to, and in reasonable anticipation of, your death.
For Organ, Eye or Tissue Donation: PHC may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation, if you so desire.