The McLeod Plan Notice of Privacy Practices This notice is effective as of September 16, 2013.
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.
Our Promise
We understand that health information about you is personal. It is the policy of the McLeod Plan to protect the privacy and integrity of your protected health information (PHI). This is required by law and by ethics. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. Required responsibilities We are required to:
- Make sure that health information that identifies you is kept private;
- To give you this Notice of our legal duties and privacy practices with respect to health information that we collect and maintain about you;
- To follow the terms of this Notice that are currently in effect.
Your Privacy Rights
- Right to review and ask for a copy – You have the right to inspect and ask, in writing, to see and get a paper or electronic copy of the PHI the McLeod Plan has about you. The McLeod Plan has the right to say we cannot do as you ask. If you are denied the right to see or copy your medical information, you may ask us to think about it. We may ask a licensed health care professional to review the denial and we will follow their decision. We have up to 30 days to make your information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request.
- Right to an electronic copy – You have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity if your PHI is maintained in an electronic format. We will make every effort to provide access to your information in the form or format you request. We will provide a readable hard copy of the information if we cannot produce it in the requested form or format. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
- Right to get notice of a breach – You have the right to be notified, in writing, if we discover a breach of your unsecured PHI and determine through a risk assessment that notification is required. We may use or disclose your protected health information to provide legally required notices of unauthorized access to or disclosure of your health information.
- Right to amend – If you feel your PHI is not complete, you may ask us, in writing, to add to the information. You must provide a reason why the information is to be added. The McLeod Plan has the right to say we cannot do as you ask. We will tell you if we cannot do what you ask.
- Right to an accounting of disclosures – You have the right to ask, in writing, for a list of who was made known of your PHI we made in the last six years prior to the date you request the accounting. This list will not include those who were part of your treatment, those who helped to get payment, those who do McLeod Plan management, those who you allowed us to share your information, and anything before April 14, 2003.
- Right to ask restrictions on disclosures – You have the right to ask,
in writing, to not use or to limit the PHI we make known about you for treatment, payment or hospital management or to someone involved in your care or the payment for your care, like a family member or friend. The McLeod Plan has the right to say we cannot do as you ask. However, if we do agree, we may need to use the information for emergency treatment or to obey the law.
- Right to ask restriction to a health plan – You have the right to ask us to not send your PHI to a health plan for payment or health care operations purposes if the information has to do with a health care item or service for which you have paid us in full and out of pocket. We will honor this request.
- Right to ask confidential communications – You have the right to ask, in writing, that we get in touch with you about your PHI in a certain way such as only at work or by mail. We will do as you ask, within reason, however you must provide us with information about how payment, if any, will be handled. We will not ask why you are asking us to do this.
- Right to a paper copy of this notice – You have the right to receive a paper copy of this Notice at any time even though you may have agreed to receive it by computer. You may obtain a copy from the Corporate Human Resources Department.
The McLeod Human Resources Department has the request forms to fill out and can tell you if there will be a cost.
Uses And Disclosures Of Your Protected Health Information
- Treatment – We may use and disclose your PHI to health care providers to help them treat you. For example, our care managers may disclose PHI to a home health care agency to make sure you get the services you need after discharge from the hospital.
- Payment – We may use and make known your PHI for payment purposes such as paying doctors and hospitals for covered services. Payment purposes also include activities such as; determining eligibility for benefits; reviewing services for medical necessity; performing utilization review; obtaining premiums; coordinating benefits, subrogation, and collection activities.
- Health care operations – We may use and make known your PHI for the management of the McLeod Plan such as reviewing our claims experience and to make determination with respect to the benefit options that we offer to employees. We do not use or disclose your PHI that is genetic information for underwriting purposes.
- Health and wellness information – We may use your PHI to contact you with information about appointment reminders; treatment alternatives; therapies; health care providers; settings of care; or other health related benefits, services and products that may be of interest to you.
- Business associates – There are some services provided in our organization through contracts with business associates. An example is a claims processing administrator. To protect your health information, however, we require the business associate to appropriately safeguard your information.
- Plan sponsor – We may disclose your PHI to the plan sponsor, McLeod, for purposes related to benefits and claims administration. The plan sponsor may use this information to plan for its expected expenses under the plan.
- Public health and safety; health oversight – We may disclose your PHI to a public health authority, such as DHEC, for public health activities such as responding to public health investigations, to lessen or prevent a serious threat to you or others’ health or safety and to health oversight agencies for certain activities such as audits, disciplinary actions and licensure activity.
- Legal processes, law enforcement and specialized government activities – We may disclose your PHI in the course of legal proceedings, in response to a subpoena, discovery requests or other lawful process. We may disclose your PHI to law enforcement officials in order to respond to a warrant or subpoena or for specialized governmental activities such as national security. We will disclose your PHI when required to do so by federal, state or local law.
- Death and organ/tissue donation – We may disclose your PHI to funeral directors or coroners, if required by law, to enable them to carry out their lawful duties. Your PHI may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
- Workers’ Compensation – We may disclose your PHI for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Family, friends and personal representatives – We may disclose PHI to a family member, relative or a friend that you identify as follows:
a. when you are present and agree prior to the use or disclosure, or
b. when you are incapacitated or in an emergency, or in the exercise of our professional judgment we determine that the disclosure is in your best interest. We will only disclose the PHI that is relevant to the person’s involvement in your health care or payment related to your health care. Unless prohibited by law we may disclose you PHI to your personal representative. Personal representatives may be someone named in a durable power of attorney or a parent or guardian of an un-emancipated minor.
- Communications – We will communicate information containing PHI to the address or telephone number we have on record for the subscriber of your health benefits plan. We may mail information containing your PHI to the subscriber. For example; communication regarding member requests for reimbursement may be addressed to the subscriber.
Note: South Carolina and Federal Law provide protection for certain types of health information, including information about prescription drugs, neonatal testing, alcohol or drug abuse, mental health and sexually-transmitted diseases, including AIDS/HIV, and may limit whether and how we may make known information about you to others.
Other Uses Of Medical Information
Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to the McLeod Plan will be made only with your written authorization that is not part of any consent we may have obtained from you. This is your right. We will always obtain your authorization for certain uses and disclosures of psychotherapy notes, for marketing purposes and for disclosures that can be the sale of your protected health information. You may cancel that authorization, in writing, at any time. You understand that we are unable to take back any information we have already made known, we must continue to obey the laws where certain information must be made known, and we are to keep our records of the care that we provided to you.
Breach Notification
In accordance with certain revised HIPAA rules, you are entitled to receive notification if the confidentiality of any of your PHI maintained on an unsecured form is compromised. This notification may come directly from the McLeod Plan or it may come form a third party service provider working with the McLeod Plan to provide your benefits.
Changes To This Notice
We have the right to change this Notice as it relates to all PHI that we create and/or maintain. We will post the most current Notice on the McLeod Plan web site and will use one of our periodic mailings to inform subscribers about the updated Notice. We will provide a new version of our notice to you within 60 days of a material change.
Complaints
If you think there has been a problem with your privacy rights, you may file a complaint with the Corporate Compliance Officer at 843-777-8097, or the Compliance Hot Line at 888-679-3531, or the Secretary of the Department of Health and Human Services. You will not get in trouble for filing a complaint nor will treatment be withheld from you. If you have any questions about this Notice, please contact the Corporate Compliance Officer at 843-777-8097.
