Privacy Notice

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 READ THIS NOTICE CAREFULLY.

Introduction

At Senior Whole Health (SWH), we understand that your health information is personal and we value your right to privacy. We keep records of the care and services that you receive from our providers. We are committed to keeping your health information private, and we are also required by law to respect the confidentiality of your health information.

This Notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information.

We respect your right to privacy. We will not release personally identifiable information about you without your permission, unless the release is to provide service you expect from us or is otherwise in accordance with the law.

Collection of Information

We collect only personal or medical information we need to carry out our business.

  • Examples of personal information are name, address, and date of birth. Most often, you supply this information to enroll you in our health plan.
  • Examples of medical information are diagnoses, treatment, and names of providers who treat you. Most often, your providers supply this information.

Use and Release of Information Without Your Consent

We may use and disclose your information without your written authorization for the following purposes, and as otherwise permitted or required by law:

  • Treatment – to help health care providers provide, coordinate, or manage your health care and related services. For example, to refer you to another provider.
  • Payment – to obtain payment for your coverage, provide you with health benefits, and assist another health plan or provider in its payment activities. For example, to manage enrollment records, make coverage determinations, administer claims, and coordinate benefits with other coverage you may have.
  • Health Care Operations – to operate our business, including accreditation, credentialing, peer review, and fraud prevention activities. For example, to do business planning, arrange for medical review, and conduct quality assessment and improvement activities.
  • Legal Compliance – to comply with applicable law. For example, to respond to regulatory authorities responsible for oversight of government benefit programs or our operations; to parties or courts in the course of judicial or administrative proceedings; and to law enforcement officials during an investigation.
  • Research and Public Health – to report to public health authorities and otherwise prevent or lessen a serious and imminent threat to health or safety. For example, for the purpose of preventing or controlling disease, injury, or disability.
  • To a Self-Insured Account or Party It Designates – for management of its health plan. For example, for claim review and audits. Disclosure only to designated individuals, along with contract obligations, helps protect your information from unauthorized use.

To carry out these purposes, we share information with providers that perform functions for us under contracts that limit the use and disclosure of information for intended purposes. We use physical, electronic, and procedural safeguards to protect your privacy. Even when allowed, use and disclosure are limited to the minimum amount reasonably necessary for the intended task.

Use and Release of Your Information With Your Specific Written Consent

Other uses and disclosures of your health information not covered by this Notice, or the laws that apply to us, will only be made with your written permission. You may also begin the transfer of your records to another person by completing a written authorization form.

If you provide us with written authorization, you may revoke that written authorization at any time, except to the extent that we have already relied upon it. To revoke a written authorization, please write to Senior Whole Health, 58 Charles Street, Cambridge, MA 02141. You must understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provide to you.

In most cases, we will not be able to disclose the following types of health information without your written authorization or a court order:

  • HIV testing and test results
  • Genetic testing and test results
  • Sensitive information such as sexual assault counseling records or communications between you and a social worker, psychologist, psychiatrist, psychotherapist or licensed mental health nurse clinician Records pertaining to venereal diseases, including sexually transmitted diseases (except certain disclosures may be made to public health officials without a court order or your authorization)
  • Psychotherapy notes (notes maintained separate from the medical record for the therapist’s own use) (However, specific permission is not required for use or sharing of these notes if used by your therapist to treat you, for training programs, for legal defense in an action you bring, or for professional oversight of the therapist.)
  • Drug and alcohol abuse treatment

Your Privacy Rights

  • You have the right to receive information about privacy protections. Your member education materials include a notice of your rights, and you may request a copy of this notice at any time.
  • You have the right to inspect and get copies of information we collect about you. We will provide access to this information within 30 days of receiving a written request. We may charge a reasonable fee for copying and mailing records. You may also ask your providers for access to your records.
  • You have the right to receive an accounting of disclosures. Your request must be in writing. Our response will include any disclosures made in support of treatment, payment, and health care operations, or that you authorized. An example of a disclosure that would be reported to you is a release of your information in response to a subpoena.
  • You have the right to ask us to correct or amend information that you believe is incorrect. Your request to correct, amend, or delete information should be in writing. We will notify you if we make an adjustment as a result of your request. If we do not make an adjustment, we will send you a letter explaining why within 30 days. In this case, you may ask us to make your request part of your records, or ask the Commissioner of Insurance to review our decision. We may also provide notice of your requested changes to others who received this information in the past two years.
  • You have the right to authorize release of information for purposes not otherwise permitted by law. Your request and any subsequent revocation must be in writing, and a form for this purpose is available on our website.
  • You have the right to designate someone to receive information and make decisions for you. Your personal authorized representative has the same rights concerning your information as you. Your designation and any subsequent revocation must be in writing, and a form for this purpose is available on our website.
  • You have the right to ask that we restrict or refuse the release of personally identifiable information, and that we direct communications to you by alternate means or to alternate locations. While we may not always be able to agree, we will make reasonable efforts to accommodate your requests. Your request and any subsequent revocation must be in writing.

If you believe your privacy rights have been violated, you have the right to complain to us, using the standard grievance process outlined in your benefit materials, or to the Secretary of the U.S. Department of Health and Human Services, without fear of retaliation.

About This Notice

This notice is effective January 1, 2007 and applies to all protected health information as defined by federal regulations. We are required by law to provide this notice to you and to abide by it. We reserve the right to change this notice. Any changes will apply to all personal and medical information we maintain. If we make significant changes to this notice, we will send you a revised copy. If you have any questions, we’re here to help! Please call Member Services at 1-866-211-1777 or TTY 1-866-404-9507. Our hours of operation are weekdays, Monday through Friday, from 8AM to 8PM, and also on Saturdays and Sundays from November 15th to March 1st. Interpreter services are available upon request. You may also write to us at Senior Whole Health, 200 South Pearl Street, Albany, NY 12202.

Last modified: 04/01/2010

C1009_M1009_100 12/4/06