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.
Denver Health Medical Plan, Inc. (DHMP) and Elevate Medicaid Choice (DHMC), hereinafter referred to collectively as the “Company,” respects the privacy of your health information and will protect your information in a responsible and professional manner. We are required by law to maintain the privacy of your health information and to send you this notice.
This notice explains how we use information about you and when we can share that information with others. It also informs you of your rights with respect to your health information and how you can exercise those rights.
When we talk about “information” or “personal health information” in this notice, we mean personal information that may identify you or that relates to health care services provided to you; the payment of health care services provided to you; or your past, present, or future physical or mental health.
We are required to follow the terms of this notice until it is replaced. We reserve the right to change the terms of this notice and to make the new notice effective for all protected health information we maintain. Once revised, the new notice will be available upon request, on our website at denverhealthmedicalplan.org, or we can mail a copy to you.
Our Uses and Disclosures:
Federal law allows us to use or share protected health information for the purposes of treatment, payment, and health care operations without your authorization.
The following are ways we may use or share information about you:
- To pay for your health services and make sure your medical bills sent to us for payment are handled the right way.
- To help your doctors or hospitals provide medical care to you.
- To help manage the health care treatment you receive.
- To conduct health care operations such as: quality assessment and improvement activities; care coordination; and underwriting or premium rating.
- With others who conduct our business operations. For example, consultants who provide legal, actuarial, or auditing services, or collection activities. We will not share your information with these outside groups unless they agree to keep it protected.
- For certain types of public health or disaster relief efforts.
- To give you information about alternative health care treatments, services, and programs you may be interested in, such as a weight-loss program.
- With the plan sponsor as necessary for plan administration.
We will not share detailed health information with your health benefit Plan Sponsor for employment or other benefit related decisions. We will never share your genetic information for underwriting purposes.
State and Federal Laws Pertaining to Personal Health Information:
There are also state and federal laws that may require us to use or share your health information without your authorization. For example, we may use or share protected health information as follows:
- If you are injured or unconscious, we may share PHI with your family or friends to ensure you get the care you need and talk about how the care will be paid for.
- To a personal representative designated by you or by law.
- To state and federal agencies that regulate us, such as the US Department of Health and Human Services, Colorado Division of Insurance, Colorado Department of Public Health and Environment, and the Colorado Department of Health Care Policy and Financing.
- For public health activities. This may include reporting disease outbreaks or helping with product recalls.
- To public health agencies if we believe there is a serious health or safety threat.
- With a health oversight agency for certain oversight activities, such as: audits, inspections, licensure, and disciplinary actions.
- To a court or administrative agency, for example, pursuant to a court order or search warrant.
- For law enforcement purposes or with a law enforcement official.
- To a government authority regarding child abuse, neglect, or domestic violence.
- To respond to organ and tissue donation requests and work with a funeral director or medical examiner.
- For special government functions, such as for national safety.
- For job-related injuries because of state worker compensation laws.
The examples above are not provided as an all-inclusive list of how we may use or share information. They are provided to describe in general the ways in which we may use or share your information.
Other uses and Disclosures of Health Information:
If one of the above reasons does not apply, we must get your written permission (or authorization) to use or share your health information. Upon authorization, PHI will be used or disclosed only in the manner authorized by you. If you give us written permission and later change your mind, you may revoke the authorization at any time by providing us with written notice of your desire to revoke the authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or shared information in good faith with the authorization.
We will also not use or disclose your health information for the following purposes without your specific, written Authorization:
- For our marketing purposes. This does not including face-to-face communication about products or services that may be of benefit to you and about prescriptions you have already been prescribed.
- For the purpose of selling your health information. We may receive payment for sharing your information for, as an example, public health purposes, research and releases to you or others you authorize as long as payment is reasonable and related to the cost of providing your health information.
- For fundraising. We may contact you for fundraising campaigns. Please notify us if you do not wish to be contacted during fundraising campaigns. If you advise us in writing that you do not wish to receive such communications, we will not use or disclose your information for these purposes.
Your Rights Regarding Personal Health Information
The following are your rights with respect to your health information. If you would like to exercise the following rights, please contact the Privacy Officer by telephone at 303-602-7025, or via email at firstname.lastname@example.org, Monday through Friday between the hours of 8 a.m. and 5 p.m., or by U.S. mail at or walk-in at:
Attn: Privacy Officer
777 Bannock St.
Mail Code 1919
Denver, CO 80204
You have the right to ask us to restrict how we use or disclose your information for treatment, payment, or health care operations. You also have the right to ask us to restrict information that we have been asked to give to family members or to others who are involved in your health care or payment for your healthcare. Any such request must be made in writing to our Privacy Officer, and must state the specific restriction requested and to whom that restriction would apply.
Please note that while we will try to honor your request, we are not required to agree to a restriction. If we do agree, we may not violate that restriction except as necessary to allow the provision of emergency medical care to you or as may be required by law.
We are required to agree to your request for a restriction if you pay for treatment, services, supplies and prescriptions “out of pocket” and you request the information not be communicated to your health plan for payment or health care operations.
You have the right to ask to receive confidential communications of information. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will consider all reasonable requests and must say “yes” if you tell us you would be in danger if we do not. Any such request must be made in writing to the Privacy Officer.
You have the right to inspect and obtain a copy of information that we maintain about you. You have the right to obtain such information in an electronic format and you may direct us to send a copy directly to your designee, provided we receive a clear and specific written request to do so.
However, you do not have the right to access certain types of information and we may decide not to provide you with copies of information:
- contained in psychotherapy notes (which may, but are not likely to, come into our possession);
- compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action or proceeding;
- and subject to certain federal laws governing biological products and clinical laboratories.
In certain other situations, we may deny your request to inspect or obtain a copy of your information. If we deny your request, we will notify you in writing and may provide you with a right to have the denial reviewed.
You have the right to ask us to make changes to information we maintain about you. These changes are known as amendments. Your request must be made in writing to the Privacy Officer, and you must provide a reason for your request. We will respond to your request no later than 60 days after we receive it. If we are unable to act within 60 days, we may extend that time by no more than an additional 30 days. If we need to extend this time, we will notify you of the delay and the date by which we will complete action on your request.
If we make the amendment, we will notify you that it was made. In addition, we will provide the amendment to any person that we know has received your health information from us. We will also provide the amendment to other persons identified by you.
If we deny your request to amend, we will notify you in writing of the reason for the denial. Reasons may include that the information was not created by us, is not part of the designated record set, is not information that is available for inspection, or that the information is accurate and complete. The denial will explain your right to file a written statement of disagreement. We have a right to respond to your statement. However, you have the right to request that your written request, our written denial, and your statement of disagreement be included with your information for any future disclosures.
You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request. We are not required to provide you with an accounting of the following:
- Any information collected prior to April 14, 2003;
- Information disclosed or used for treatment, payment, and health care operations purposes;
- Information disclosed to you or pursuant to your authorization;
- Information that is incident to a use or disclosure otherwise permitted;
- Information disclosed for a facility’s directory or to persons involved in your care or other notification purposes;
- Information disclosed for national security or intelligence purposes;
- Information disclosed to correctional institutions, law enforcement officials, or health oversight agencies;
- Information that was disclosed or used as part of a limited data set for research, public health, or health care operations purposes.
Your request must be made in writing to the Privacy Officer. We will act on your request for an accounting within 60 days. We may need additional time to act on your request. If so, we may take up to an additional 30 days. Your first accounting will be free. We will continue to provide you with one free accounting upon request every 12 months. If you request an additional accounting within 12 months of receiving your free accounting, we may charge you a fee. We will inform you in advance of the fee and provide you with an opportunity to withdraw or modify your request.
Please be advised that oral, written, and electronic PHI is protected internally. In the case of a breach, we have a duty to notify affected individuals of a breach of PHI. We protect PHI by locking sensitive information away in a safe place, adhering to confidentiality rules and not discussing personal and sensitive information while in personal and common areas, and lastly, our internal computers systems will be automatically encrypting all emails that contain PHI.
You have a right to receive a copy of this notice upon request at any time.
Requests for a copy of this notice should be directed to the Privacy Officer.
Questions Or Complaints
If you have any questions about this notice, how we use or share information, or if you believe your privacy rights have been violated, please contact the Privacy Officer at 303-602-7025, or via email at email@example.com, Monday through Friday between the hours of 8 a.m. and 5 p.m. You may also contact us by US mail:
Attn: Privacy Officer
777 Bannock St.
Mail Code 1919
Denver, CO 80204
You can file a complaint with the Secretary of the U.S. Department of Health and Human Services by calling 877-696-6775, or by writing:
Secretary of the U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Ave. S.W.
Washington, D.C. 20201
We will not take any action against you for filing a complaint.
Original Effective Date: April 14, 2003
Revised Effective Date: September 23, 2013