Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO | Fall 2019 | Your Story
10 Our commitment to your privacy—HIPAA Information about your health is deeply personal, and we work hard to protect it. Guarding these sensitive details about your life is our policy and practice. It’s also the law. The Health Insurance Portability and Accountability Act—often called HIPAA— is the federal law that gives you rights over your records. It applies to most doctors, nurses, pharmacists, and many other providers and programs. It also applies to hospitals, health plans, Medicare, and Medicaid. Because of HIPAA, you can: ● ● Ask to see your health records. You can also get a copy of your records for a reasonable fee. This is true even if you haven’t paid your bill. ● ● Add corrections to your health records. ● ● Request that certain people or providers not be given information about your health or treatment. ● ● Decide if you want to allow your health information to be used for certain purposes, like marketing. ● ● Get a report on when and why your information was shared or used. ● ● File a complaint if you think your rights or privacy have been violated. HIPAA spells out other rights too. For example, it allows you to ask to be contacted somewhere other than at home. That means you can ask to get test results where you want them, such as work. Whywe might share records There are some good—and approved— reasons to use or share patient information. We may need it to: ● ● Comply with laws, such as reporting influenza and other public health risks ● ● Coordinate your treatment and care ● ● Pay providers ● ● Analyze the quality of treatment, providers, and institutions But remember: Your health information cannot be used or shared without your written permission, unless HIPAA allows it. The right care at the right time We want our members to get the best care, in the best place, at the right time. One of the ways we do this is by using a prior authorization process. Prior authorization is part of our Utilization Management Program. This program helps ensure that the services our members receive are medically necessary. This means that the care you receive is needed to diagnose, treat, or prevent medical conditions. It also helps ensure that the medical facilities, such as hospitals, are being used in the right way. We do not reward or pay healthcare providers for not providing services. We also do not reward or pay healthcare providers for not referring you for care. Your providers and Presbyterian staff members consider these factors when making decisions about your care: • Is the service or care covered by your health plan? • Is the service or care appropriate for your healthcare needs? To learn more about the Utilization Management Program, call the customer service number on your member ID card. Always vigilant Protecting your private medical information is important to us, just as it is to you. We’re here to answer any questions you might have about your rights or about our responsibilities and safeguards. Visit www.phs.org to learn more.