Notice of Privacy Practices
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.
In order to provide you with the benefits to which you are entitled, Hudson Health Plan (Hudson) must collect, create and maintain health information about you. Hudson is required by law to maintain the privacy of this information. This Notice of Privacy Practices describes how Hudson uses and discloses your health information, and explains certain rights you have regarding this information. Hudson is required by law to provide you with this Notice.
How Hudson Uses and Discloses Your Health Information
Hudson may use and disclose your health information without your authorization for the following purposes:
Treatment, Payment, and Health Care Operations
Hudson uses and discloses your health information to administer your benefits and perform other necessary business functions. We use and disclose your health information for the following purposes:
We use and disclose health information about you to facilitate treatment by health care providers. For example, if one of our participating health care providers is treating you, we will disclose to this provider health information relating to other health care services you have received that may be relevant to the provider’s treatment.
We use and disclose health information about you for our own payment purposes and to assist in the payment activities of other health plans and health care providers. Our payment activities include collecting premiums, determining your eligibility for benefits, reimbursing health care providers that treat you and obtaining payment from other insurers that may be responsible for providing coverage to you. For example, if a health care provider submits a bill to us for services you received, we will use health information about you to determine whether these services are covered under your benefit plan and the appropriate amount of payment to which the provider may be entitled.
Health care operations
We use and disclose health information about you to carry out health care operations, which includes quality improvement activities, evaluating our own performance and resolving any complaints or grievances you may have. For example, we may collect and review records maintained by doctors and hospitals that have treated you to see whether they have provided you with preventive treatment and other important health services that are recommended by medical authorities. We also use and disclose your health information to assist other health plans and health care providers in performing certain health care operations, such as quality assessment and improvement, reviewing the competence and qualifications of health care providers and conducting fraud detection or investigation.
Uses and Disclosures Without Your Authorization
Hudson may use and disclose your health information without your authorization for the following purposes:
As required by law
We may use and disclose your health information as required by state, federal or local law.
For public health activities
We may disclose your health information to public health authorities or other agencies and organizations conducting public health activities, such as preventing or controlling disease, injury or disability and reporting births, deaths, child abuse or neglect, domestic violence, potential problems with products regulated by the Food and Drug Administration or communicable diseases.
About victims of abuse, neglect or domestic violence
We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect or domestic violence and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your health information for this purpose unless we believe that letting you know would place you at risk of serious harm.
For health oversight activities
WWe may disclose your health information to health oversight agencies (i.e., New York State Department of Health) for oversight activities authorized by law such as audits, investigations, inspections and licensing surveys.
For judicial and administrative proceedings
We may disclose your health information in the course of any legal or administrative proceeding in response to an order of a court or administrative body.
For law enforcement purposes
We may disclose your health information to a law enforcement official for a legitimate law enforcement purpose such as: identifying or locating a suspect, fugitive or missing person; complying with a court order, subpoena or administrative request; providing information about a victim of a crime or reporting a death that may be the result of a crime.
We We may use or disclose your health information to study ways to provide better health care. We may, for example, compare the benefits of alternative treatments received by our members or investigations into how to improve our enrollment and education procedures..
To avert a serious threat to health or safety
We may use or disclose your health information to prevent or lessen a serious and immediate threat to your health or safety or to the health or safety of another person or the general public. We will disclose your health information for this purpose only to someone who may be able to prevent or lessen this type of threat.
For specialized government functions
We may use or disclose your health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your health information to appropriate military authorities, as they deem necessary to carry out military missions. We may also disclose your health information to federal officials for lawful intelligence or national security activities and for the purpose of providing protective services to the President of the United States and other officials.
For workers' compensation
We may use or disclose your health information as permitted by the laws governing the workers’ compensation program or similar programs that provide benefits for work-related injuries or illnesses.
To individuals involved in your care
We may disclose your health information to a family member, other relative or close personal friend assisting you in receiving or obtaining payment for health care services. For minors, we will disclose your information to your parent or guardian, or other individual responsible for your care. We will disclose your health information to these individuals only if you tell us to do this or if we advise you that we will do so and you do not object. We may also disclose your health information to disaster relief organizations such as the Red Cross to assist your family members or friends in locating you or learning about your general condition in the event of a disaster.
Obtaining Your Authorization for Other Uses and Disclosures
Hudson will not use or disclose your health information for any purpose not specified in this Notice of Privacy Practices unless we obtain your written authorization. Additionally, Hudson must obtain your authorization prior to any use and disclosure of psychotherapy notes, the use of your information for marketing purposes, and the sale of PHI. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for the purpose you authorized after the date you revoke your authorization. Hudson is prohibited from using or disclosing PHI that is genetic information of an individual for underwriting purposes.
Your Rights Regarding Your Health Information
You have the following rights regarding your health information:
Right to inspect and copy
You have the right to inspect or request a copy of health information about you that we maintain and that we may use in making decisions about your benefits. We may refuse to allow you to inspect or obtain copies of this information in certain limited cases.
Right to request amendments
You have the right to request changes to any health information we maintain about you if you state a reason why this information is incorrect or incomplete. We do not have to agree to make the changes you request. If we do not believe the changes you requested are appropriate, we will notify you in writing how you can have your objection to our decision included in our records.
Right to an accounting of disclosures
You have the right to receive a list of disclosures of your health information that have been made by Hudson. The list will not include disclosures made for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period for which you want this list and may not include dates prior to April 14, 2003.
Right to request restrictions
You have the right to request restrictions on the ways in which we use and disclose your health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. We do not have to agree to the restrictions you request.
Right to request confidential communications
You have the right to ask us to send health information to you in a different way or at a different location if you believe that you may be endangered by our ordinary form of communication. For example, if you are afraid that someone living with you may open mail we send you and harm you as a result, you can ask us to send your mail to a relative’s or employer’s address. You must state in your request that you believe you will be endangered by our ordinary form of communication but you do not have to explain why you believe this is the case. Your request should also specify where and/or how we should contact you. We will accommodate all reasonable requests.
Right to Paper Copy of Notice
You have the right to receive a paper copy of this Notice of Privacy Practices at any time.
Right to restrict disclosure of PHI to a health plan
You have the right to restrict disclosure of PHI to Hudson Health Plan where you have paid a provider out of pocket in full for the providers services.
Right to be notified of a breach
You have the right to be notified after a breach of unsecured PHI.
If If you believe your privacy rights have been violated, you may file a complaint with Hudson or the New York State Department of Health. You will not be penalized or retaliated against by Hudson for filing a complaint. You may file a complaint with Hudson by writing to: Manager of Customer Care, Hudson Health Plan, 303 South Broadway, Suite 321, Tarrytown, NY 10591, or calling (800) 339-4557, or the NYS Department of Health at (518) 486-6074.
You may also report a complaint to: The Office for Civil Rights, Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, NY 10278; (800) 368-1019; Fax (212) 264-3039; or TDD (800) 537-7697.
Changes to this Notice
Hudson may change the terms of this Notice of Privacy Practices at any time. If we change the terms of this Notice, the new terms will apply to all of your health information, whether created or received by Hudson before or after the date on which the Notice is changed. We will notify you of changes to this Notice by posting the revised notice on our website (www.hudsonhealthplan.org) and notifying you in our next newsletter mailing to Hudson members..
Contact for Requesting Information
You may ask to inspect or obtain copies of your information, request changes to your health information, request a list of disclosures, request a restriction on the use or disclosure of your health information, request to send health information to you in a different way or at different location, or obtain copies of this Notice by writing to the Manager of Customer Care, Hudson Health Plan, 303 South Broadway, Suite 321, Tarrytown, NY 10591, or calling 1-800-339-4557.
If you have any questions or would like additional information about this Notice or Hudson’s privacy practices, please contact the Customer Care Department by calling 1-800-339-4557.
This Notice of Privacy Practices is effective as of April 1, 2013.