Information about you may be
Used and disclosed, and how you
Can get access to this information.
Please review it carefully.
WHAT IS HIPAA?
In 1996, as part of its goal of achieving administrative simplification in the health care system, Congress passed the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). HIPAA’s administrative simplification provisions cover the standardization of electronic health care transactions, security of confidential information and the privacy of individually identifiable health information.
In 1998, the Department of Health and Human Services (“DHHS”) issued proposed security regulations, which set the minimum standards for the security of individual health information under HIPAA. In 1999, DHHS followed its security regulations with proposed rules governing the privacy of individual health information, which put limits on the use and disclosure of such information by particular entities. Both sets of regulations were lengthy and complex. In December 2000, the Clinton Administration consolidated and finalized the proposed DHHS security and privacy regulations and issued a more streamlined final privacy rule.
Although the privacy rule took effect in April, the majority of entities subject to HIPAA have until April 14, 2003 to be in compliance with the rule. Entities qualifying as “small health plans” (those with $5 million or less in annual receipts), have until April 14, 2004 to be in compliance.
At PBO, Inc. we are dedicated to keeping your health information private, in accordance with federal and state law. As required by the Federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), we provide you with this notice of our legal duties with respect to health information. We are required to follow the terms of this notice currently or any revision to it that is in effect. We reserve the right to make changes to this notice as allowed by law. Changes to our privacy practices will apply to all health information we maintain.
If we change this notice, you can access the revised notice posted on our website: (www.pbo.com).
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION.
We may use your health information and disclose it to appropriate persons, authorities and agencies, as allowed by federal and state law. We may do this without your written permission for the following purposes:
Treatment. We may need to use and disclose your health information to other health care providers within or outside the servicing providers. For example, a doctor may use the information in your medical record to find the best treatment option for you or a pharmacist, therapist, pain clinic or possible second opinion. In some cases, our staff may use or disclose your health information to help your doctor manage your disease.
Payment. We may use your health information and disclose it to insurance companies or employer health plans, and to others in order to receive payment for your bill. For example, as a courtesy to you we submit a claim to your insurance carrier that states your name, diagnosis, procedure, and other information in order for us to receive payment. In certain situations, we may disclose your health information to a collection agency if a bill is not paid.
Health Care Operations. We may use the information in your medical record to help improve the quality or cost or to respond to appropriate questions about the care provided. For example, we may study how doctors manage patient treatment after surgery, to learn the best way to help patients recover. We may use your health information to look a the care your received from doctors or other health care professionals. We may disclose your health information to another health care professional that your have seen so they may improve their quality or cost.
We may also use and disclose your health information without your written permission for the following purposes:
Disaster Relief Efforts. We may disclose your health information to organizations for the purpose of disaster relief efforts.
Required by Law. We may disclose your health information when required by law to do so.
Health Care Oversight. We may disclose your health information to authorities and agencies for oversight activities allowed by law, including audits, investigations, inspections, licensing, disciplinary actions, or legal proceedings. These activities are necessary for oversight of the health care system, government programs and civil rights laws.
Legal Proceedings. We may disclose your health information in the course of certain legal proceedings. For example, we may disclose your information in response to a court order.
Law Enforcement. We may disclose your health information to law enforcement officials for specific purposes. For example, we may disclose your health information when required by law to report certain injuries.
Military, National Security, Law Enforcement Custody. We may disclose your health information to the proper authorities so they may carry out their duties under the law. This applies if you are or were involved with the military, national security or intelligence activities. It also applies if you are in the custody of law enforcement officials or an inmate in a correctional institution.
Workers’ Compensation. We may disclose your information in order to comply with the laws related to workers’ compensation or similar programs. These programs may provide benefits for work-related injuries or illness.
We may use or disclose your information only with your written authorization, except as described in the previous segment. If you give us your permission, you may withdraw such consent at any time by notifying us in writing, with the exception if we have already taken action based upon your authorization.
Please be aware that state and federal law may have more requirements than HIPAA on how we use and disclose your health information. If there are specific more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written authorization as required by such laws. We may be required by law to obtain your written permission to use and disclose your information related to treatment for a mental illness, developmental disability, or alcohol or drug abuse.
There may be other restrictions on how we use and disclose your health information than those listed above. We believe state and federal laws discussing such restrictions are in the Wisconsin/Illinois/Michigan and Minnesota Statutes.
YOUR HEALTH INFORMATION RIGHTS.
As a patient or customer who receives services from any one of our Servicing Providers, you have the right to:
Read and copy your health information. With a few exceptions, you have the right to read and obtain a copy of your health information. We may charge you a reasonable fee if you want a copy of your health information. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
v To obtain your health information, contact the Medical Record Department of the facility where you were treated.
v To obtain your billing information, contact the Billing Office in your area.
Request to correct your health information. If you believe there is an error in your health information or something has been omitted, you may contact the provider of service or servicing facility. You must make the request in writing and give the reason why your health information should be changed.
Request to restrict certain uses and disclosures of your information. You have the right to ask that we restrict how your health information is used or disclosed. Under the law, we are not required to agree to your request. In some cases, we may not be able to agree to your request, as we do not have a way to tell everyone who would need to know about the restriction. There are other instances in which we are not required to agree with your request. We will inform you when we cannot find a way to carry out your request. You may request a restriction in these ways:
v Contact the billing office in your area.
v Contact the Medical Record Department of the servicing provider or facility.
Receive information at a different place or by different means. You have the right to ask that we send information to you in different ways or at different places. For example, you may wish to receive a test result or report at an address other than your home address. We will grant reasonable requests.
Receive a record of how we disclosed your health information. You have the right to ask us in writing for a list of places or persons to whom your health information was disclosed during the past six years. The list will contain the date your health information was disclosed to others, who received the information, a brief description of what was disclosed and why. However, the list will not include disclosures for the following purposes; treatment, payment, health care operations, family and friends for care and payment, national security or intelligence, and law enforcement/corrections. In addition, the list will not include information that was disclosed to your and to others with your permission, incidental disclosures and disclosures of limited or de-identified health information. We must provide you the list within 60 days of your request, unless you agree to a 30-day extension. You will not be charged for this list, unless you request more than one list per year.
v The request must be for health information disclosed on or after April 14,2003.
v To request this list, contact the Medical Record Department at the facility where you were treated.
Obtain a paper copy of this notice. Upon your request, you may at any time receive a paper copy of this notice. This notice is available at the servicing facility.
File a complaint. You have the right to file a complaint with us if you believe your privacy rights have been violated. To file a complaint, call the Privacy Officer at (800) 690-7792 or (800) 236-7864. You also have the right to complain to the United States Secretary of the Department of Health and Human Services. We will not take any action against you for filing a complaint.
If you have questions or concerns about your privacy rights, PBO, Inc.’s privacy-related policies or the information contained in this notice, please contact our Privacy Officer at (800) 690-7792 or (800) 236-7864.
The following persons and entities, who have agreed to be bound by this notice, will jointly use this notice for convenience to meet federal law requirements; provided that, each person and entity is solely and separately responsible and liable for complying with this notice and applicable law (and PBO, Inc. and its affiliates are only liable for their own violations):
v All employed staff of PBO, Inc., including staff of other affiliated entities.
v Any health care professional that agrees to be bound by this notice and who treats you at any of our facilities with respect to your information stored at the facility.
v Any of our business partners or associates with whom we share health information and who agrees to be bound by this notice.
This notice is effective on and after April 14, 2003, unless and until it is revised by PBO, Inc.