Notice of Rights*
THIS NOTICE OF PRIVACY PRACTICES (“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. We are required by law to keep your health information private and provide you with a copy of this Notice. We are also required by law to abide by the terms of this Notice a long as it is in effect. If you have any questions about this Notice, please contact us at 414-937-2020 and request to speak with our Privacy Officer.
How Your Health Information May be Used and Disclosed:
We may use and disclose health information about you to:
Assist in payment activities. These activities include determining eligibility for plan benefits, facilitating payment for the treatment and payment for services you receive from health care providers, determining plan responsibility for benefits, and coordinating benefits. For example, payment functions may include reviewing the medical necessity of health care services, or determining whether a treatment is covered under your plan.
Assist in health care operations. These include carrying out necessary insurance-related activities. For example, such activities may include activities relating to plan coverage; conducting quality assessment and improvement activities; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; and business planning, management and general administration.
Your health information may be disclosed to a doctor or a hospital if necessary to assist in your treatment.
Your health information may be disclosed to another entity that has a relationship with you and is subject to the federal Privacy Rules, for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing heath care fraud and abuse.
Your health information may be disclosed to the sponsor of your group health plan for purposes administering benefits under the plan.
If you agree or, if your are unavailable to agree, when the situation, such as medical emergency or disaster relief, indicates that disclosure would be in your best interest, your health information may be disclosed to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health cares.
Health information about you may be shared with family members or friends when you indicate are involved in your medical care. In certain disasters and related emergency situations, health information about you may be shared with disaster relief organizations (such as the Red Cross, etc.) so that your family can be notified about your condition, status and location.
Health information about you may be used or disclosed without your permission only as allowed by law. Examples of situations that may require release of health information about you include: emergencies, as a matter of public health record, health or safety threats, health oversight and audit activities, national security, research studies, coroners, medical examiners, funeral directors, organ/tissue donation, and workers’ compensation. It may also be required by the law to provide health information about you in response to request from law enforcement officials in limited circumstances, correctional institutions, or as part of legal proceedings in response to valid juridical or administrative orders and/or other valid legal authority.
Other Uses of Health Information
Uses or disclosure of your health information that are not covered by this Notice or the law will be made only with your written permission. (This includes those used for marketing purposes other than materials sent to you about health care services or other treatment options.). In further support of your right to privacy, your authorization to disclose health information cannot be accepted for treatment you have not yet received. If you permit the use of health information about you, you may take back that permission, in writing, at any time. If you take back your permission, the health information you specified will no longer be used or shared for the reasons you wrote. You understand that when you take back your permission any information that may have already been shared cannot be retrieved. It is also a requirement that all original records of the care provided to you be maintained.
Your Right Regarding Health Information About You
You have the right to see and receive a copy of health information about you. To do so, you must submit your request in writing to Milwaukee Center For Independence’s (MCFI’s) Case Record Department. If you request a copy, it must be requested in advance and a fee may be charged for the cost of copies, postage and/or other supplies. In certain situations, your request may be denied. If this occurs, you will be informed, in writing why your request was denied and your right to have the denial reviewed.
If you feel that the record of your health information is incorrect or incomplete, you have the right to request to amend the information. You may do this by sending your request in writing to MCFI’s Case Record Department, including your reason for the request. Your request may be denied if the information was not created by MCFI, or not a part of the health information maintained by MCFI or if it is determined that the health information is correct. You may appeal our decision by sending a written request to MCFI, Attention: Privacy Officer.
You have the right to request a list of disclosures of your health information, except for information disclosures for payment of health care operations, or for those disclosures not specifically authorized. To request this list, you must send your request in writing to MCFI’s Case Records Department. Your request must specify a time period (beginning after April 14, 2003) of not more than six years. The first disclosure list you request in any 12 – month period is free. A fee may be charged for additional lists.
You have the right to ask that the use and disclosure of health information about you may be limited. You may do so by submitting a request in writing to MCFI’s Case Records Department, identifying how and what information to limit. Your request will be considered, but it is not legally required that your request be honored. If agreed to, your request will be honored unless the information is needed to provide you emergency treatment.
You have the right to ask that information be sent to you at a different address (for example, sending information to your work address instead of your home address) or in a different way, (for example, in an unmarked envelope instead of a regular mailing envelope.). You may do so by sending a request in writing to MCFI’s Case Record Department. MCFI has the right to determine whether the request is reasonable. Compliance with an unreasonable request is not required.
You have the right to request additional copies of this Notice at any time.
If you believe your privacy or any part of this Notice has been violated, you may file a complaint with Milwaukee Center for Independence, 2020 West Wells Street, Milwaukee WI 53233. You may also file a complaint with the Secretary of the Department of Health and Human Services or the Federal Office of Civil Rights. You will not be penalized for filing a complaint.
Changes to this Notice
We reserve the right to change this Notice and our privacy policies at any time. Before we make an important change to our policies, we will promptly review this Notice and provide a copy to each then-current enrollee. Any changes will apply to the health information we have on file and health information we create or receive after the effective date of the new Notice. We will provide you with a copy of the revised Notice. You may also obtain a copy from MCFI’s Case Records Department. The effective date of this Notice is: April 13, 2003.