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Privacy Notice
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.
By law, Arkansas Blue Cross and Blue Shield and its affiliated company (referred
to for convenience as a group as "Arkansas Blue Cross") is required to protect the
privacy of your protected health information. We must also give you this notice
to tell you how we may use and give out ("Disclose") your protected health information
held by us.
Throughout this notice we will use the name "Arkansas Blue Cross" as a short-hand
reference for not only Arkansas Blue Cross and Blue Shield, but also for its affiliated
company, HMO Partners, Inc., d/b/a Health Advantage. Please note that although we
are combining this privacy notice in this way for convenient, short-hand reference,
and to make it more efficient to inform you about your privacy rights, these companies
remain separate companies, each with their own operations, management, and compliance
responsibilities.
Arkansas Blue Cross must use and give out your protected health information
to provide information:
- To you or someone who has the legal right to act for you (your personal representative)
- To the Secretary of the Department of Health and Human Services, if necessary to
make sure your privacy is protected, and
- Where required by law
Arkansas Blue Cross has the right to use and give out your protected health information
to pay for your health care and to perform business operations. For example:
- We can use your protected health information to pay or deny your claims, to collect
your premiums, or to share your benefit payment with other insurer(s).
- We can use your protected health information for regular health-care operations.
Members of our staff may use information in your health record to assess our efficiency
and outcomes in your case and others like it. This information will then be used
in an effort to continually improve the quality and effectiveness of benefits and
service we provide.
- We may disclose protected health information to your employer if your employer arranges
for your insurance. If your employer meets the requirements outlined by the Privacy
law, we can disclose protected health information to the appropriate areas so they
can modify benefits, work to control overall plan costs, and improve service levels.
This information may be in the form of routine reporting or special requests.
- We may disclose to others who are contracted to provide services on our behalf.
Some services are provided in our organization through contracts with others. Examples
include pharmacy management programs, dental benefits, and a copy service we use
when making copies of your health record. Our contracts require these business associates
to appropriately protect your information.
- Our health professionals and customer service staff, using their best judgment,
may disclose to a family member, other relative, close personal friend or any other
person you identify, health information relevant to that person’s involvement in
your care or payment related to your care. An example would be your spouse calling
to verify a claim was paid, or the amount paid on a claim.
Arkansas Blue Cross may use or give out your protected health information
for the following purposes, under limited circumstances:
- To State and other federal agencies that have the legal right to receive Arkansas
Blue Cross data (such as to make sure we are making proper payments)
- For public health activities (such as reporting disease outbreaks)
- For government health-care oversight activities (such as fraud and abuse investigations)
- For judicial and administrative proceedings (such as in response to a subpoena or
other court order)
- For law enforcement purposes (such as providing limited information to locate a
missing person)
- For research studies that meet all privacy law requirements (such as research related
to the prevention of disease or disability)
- To avoid a serious and imminent threat to health or safety
- To contact you regarding new or changed health plan benefits
By law, Arkansas Blue Cross must have your written permission (an "authorization")
to use or give out your protected health information for any purpose other than
payment or health-care operations or other limited exceptions outlined here or in
the Privacy regulation. You may take back ("revoke") your written permission at
any time, except if we have already acted based on your permission.
Personal Health Record ("PHR")
If you have a health benefit plan issued by Arkansas Blue Cross or Health Advantage
on or after October 1, 2007, you have a Personal Health Record or PHR. Your PHR
contains a summary of claims submitted for services you received while you are or
were covered by your health benefit plan, as well as non-claims data you choose
to enter yourself. Your PHR will continue to exist, even if you discontinue coverage
under your health benefit plan. You have access to your PHR through the Arkansas
Blue Cross or Health Advantage Web site. In addition, unless you limit access, your
physician and other health-care providers who provide you treatment have access
to your PHR. Certain information that may exist in the claim records will not be
made available to your physician and other health-care providers automatically.
To protect your privacy, information about treatment for certain sensitive medical
conditions such as HIV/AIDs, sexually transmitted diseases, mental health, drug
or alcohol abuse or family planning will only be viewable by you unless you choose
to make this information available to the medical personnel who treat you. Similarly,
non-claims data, such as your medical, family and social history, will only appear
in your Personal Health Record ("PHR") if you choose to enter it yourself. It is
important to note, that you have the option to prohibit access to your PHR completely,
either by electronically selecting to prohibit access or by sending a written request
to prohibit access to the privacy office at the address below.
Your Rights Regarding Medical Information About You
By law, you have the right to:
- See and get a copy of your protected health information that is contained in a designated
record set that was used to make decisions about you.
- Have your protected health information amended if you believe that it is wrong,
or if information is missing, and Arkansas Blue Cross agrees. If Arkansas Blue Cross
disagrees, you may have a statement of your disagreement added to your protected
health information.
- Receive a listing of those getting your protected health information from Arkansas
Blue Cross. The listing will not cover your protected health information that was
given out to you or your personal representative, that was given out for payment
or health-care operations, or that was given out for law enforcement purposes.
- Ask Arkansas Blue Cross to communicate with you in a different manner or at a different
place (for example, by sending your correspondence to a P.O. Box instead of your
home address) if you are in danger of personal harm if the information is not kept
confidential.
- Ask Arkansas Blue Cross to limit how your protected health information is used and
given out to pay your claims and perform healthcare operations. Please note that
Arkansas Blue Cross may not be able to agree to your request.
- Get a separate paper copy of this notice.
To Exercise Your Rights
If you would like to contact Arkansas Blue Cross for further information regarding
this notice or exercise any of the rights described in this notice, you may do so
by contacting customer service at the following telephone number:
Arkansas Blue Cross 1-800-238-8379
Health Advantage 1-800-843-1329
You may also get complete instructions and request forms from our Web site:
www.ArkansasBlueCross.com
www.HealthAdvantage-hmo.com
Changes to this Notice
We are required by law to abide by the terms of this notice. We reserve the right
to change this notice and make the revised or changed notice effective for medical
information we already have about you as well as any future information we receive.
When we make changes, we will notify you by sending a revised notice to the last
known address we have for you. We will also post a copy of the current notice on
Arkansas Blue Cross and Health Advantage Web sites.
Complaints
If you believe your privacy rights have been violated, you may
file a complaint with Arkansas Blue Cross or with the Secretary of the Department
of Health and Human Services. You may file a complaint with Arkansas Blue Cross
by writing to the following address:
Arkansas Blue Cross and Blue Shield Privacy Office
ATTN: Privacy Officer
P.O. Box 3216
Little Rock, AR 72201
We will not penalize or in any other way retaliate against you for filing a complaint
with the Secretary or with us.
You may also file a complaint with the Secretary of the U.S. Department of Health
and Human Services. Complaints filed directly with the Secretary must: (1) be in
writing; (2) contain the name of the entity against which the complaint is lodged;
(3) describe the relevant problems; and (4) be filed within 180 days of the time
you became or should have become aware of the problem.
Effective Date
The provisions of this Notice become effective April 14, 2003.
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