Privacy Policy

The following is a list of how we may use or disclose your PHI without your permission or authorization:

• Treatment. We may use or disclose your PHI to a physician or other healthcare provider providing treatment to you. We do this to coordinate your treatment among providers. We also do this to help us with prior authorization decisions related to your benefits.
• Payment. We may use and disclose your PHI to make benefit payments for the healthcare services you received. We may disclose your PHI for payment purposes to another health plan, a healthcare provider, or other. This is subject to the federal Privacy Rules. Payment activities may include: processing claims, determining eligibility or coverage for claims, issuing premium billings, reviewing services for medical necessity, and performing utilization review of claims.
• Healthcare Operations. We may use and disclose your PHI to perform our healthcare operations. These activities may include: providing customer services, responding to complaints and appeals, providing case management and care coordination, conducting medical review of claims and other quality assessment, and improvement activities.

In our healthcare operations, we may disclose PHI to business associates. We will have written agreements to protect the privacy of your PHI with these associates. We may disclose your PHI to another entity that is subject to the federal Privacy Rules. The entity must also have a relationship with you for its healthcare operations. This includes: quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, case management and care coordination, and detecting or preventing healthcare fraud and abuse.

• Appointment Reminders/Treatment Alternatives. We may use and disclose your PHI to remind you of an appointment for treatment and medical care with us. We may also use or disclose it to give you information about treatment alternatives. We may also use or disclose it for other health-related benefits and services. For example, information on how to stop smoking or lose weight.
• As Required by Law. If federal, state, and/or local law requires a use or disclosure of your PHI, we may use or disclose your PHI information. We do this when the use or disclosure complies with the law. The use or disclosure is limited to the requirements of the law. There could be other laws or regulations that conflict. If this happens, we will comply with the more restrictive laws or regulations.
• Public Health Activities. We may disclose your PHI to a public health authority to prevent or control disease, injury, or disability. We may disclose your PHI to the Food and Drug Administration (FDA). We can do this to ensure the quality, safety or effectiveness of products or services under the control of the FDA.
• Victims of Abuse and Neglect. We may disclose your PHI to a local, state, or federal government authority. This includes social services or a protective services agency authorized by law to have these reports. We will do this if we have a reasonable belief of abuse, neglect or domestic violence.
• Judicial and Administrative Proceedings. We may disclose your PHI in judicial and administrative proceedings. We may also disclose it in response to the following: an order of a court, administrative tribunal, subpoena, summons, warrant, discovery request, or similar legal process.
• Law Enforcement. We may disclose your relevant PHI to law enforcement when required to do so. For example, in response to a court order, court-ordered warrant, subpoena, summons issued by a judicial officer, or grand jury subpoena. We may also disclose your relevant PHI to identify or locate a suspect, fugitive, material witness, or missing person.
• Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a coroner or medical examiner. This may be needed, for example, to determine a cause of death. We may also disclose your PHI to funeral directors, as needed, to carry out their duties.
• Organ, Eye and Tissue Donation. We may disclose your PHI to organ procurement organizations. We may also disclose your PHI to those who work in procurement, banking or transplantation of cadaveric organs, eyes, and tissues.
• Threats to Health and Safety. We may use or disclose your PHI if we believe, in good faith, that it is needed to prevent or lessen a serious or imminent threat. This includes threats to the health or safety of a person or the public.
• Specialized Government Functions. If you are a member of U.S. Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose your PHI to authorized federal officials for national security, to intelligence activities, to the Department of State for medical suitability determinations, and for protective services of the President or other authorized persons.
• Workers’ Compensation. We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs, established by law. These are programs that provide benefits for work-related injuries or illness without regard to fault.
• Emergency Situations. We may disclose your PHI in an emergency situation, or if you are unable to respond or not present. This includes to a family member, close personal friend, authorized disaster relief agency, or any other person you told us about. We will use professional judgment and experience to decide if the disclosure is in your best interests. If it is in your best interest, we will only disclose the PHI that is directly relevant to the person’s involvement in your care.
• Research. In some cases, we may disclose your PHI to researchers when their clinical research study has been approved. They must have safeguards in place to ensure the privacy and protection of your PHI.