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Mercy Health Plans Notice of Privacy Practices
Effective April 14, 2003
Updated June 1, 2009
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.
MHP, Inc. by and on behalf of its wholly-owned subsidiaries
Mercy Health Plans of Missouri, Inc., Mercy Health Plans, ForeSee Health,
Inc., and Premier Benefits, Inc. (collectively referred to herein
as "we", "our" or "the Plan"), respects the privacy of its Members
and former Members and protects the security and confidentiality of their
nonpublic personal information. We have instituted internal policies to:
insure the security and confidentiality of your personal and financial healthcare
information; protect against any anticipated threats of hazards to the security
or integrity of such records; and protect against unauthorized access to
or use of information which could result in substantial harm or inconvenience
to you. We are required by law to provide you with this Notice of our legal
duties and privacy practices. This Notice explains your rights, our legal
duties, and our privacy practices.
To fulfill our responsibilities to you, the Plan may use
and disclose your protected health information for treatment, payment, and
healthcare operations, or when we are otherwise required or permitted to
do so by law. Below is further detail explaining these situations.
Treatment. We may use and disclose protected
health information with your healthcare providers (physicians, pharmacies,
hospitals and others) to assist in the diagnosis and treatment of your injury
or illness. For example, we may disclose your protected health information
to suggest treatment alternatives.
Payment. We may use and disclose protected
health information to pay for your covered health expenses. For example,
we may use protected health information to process claims. We may also ask
a healthcare provider for details about your treatment so that we may pay
the claim for your care.
Healthcare Operations. We may use and disclose
protected health information for our healthcare operations. For example,
we may use or disclose protected health information to perform quality assessment
activities or provide you with case management services.
Business Associates. We may, at times,
need to use the services of other companies in lieu of our own staff, such
as outsourcing data entry services, or, as part of our routine business,
we may require that outside entities, such as auditors perform operations
that require access to our healthcare information. In order for us to share
confidential information with these organizations, we must enter into agreements
that require them to comply with the privacy regulations of the Plan.
Plan Sponsor. If you participate in a self-funded
group health plan through your employer (plan sponsor), we may share limited
health information with your employer as necessary to perform administrative
functions. Plan sponsors that receive this information are required by law
to have safeguards in place to protect against inappropriate use or disclosure
of your information.
You or Your Personal Representative. We
must disclose your health information to you as described in the Patient
Rights section below. If you have a legally-assigned personal representative
or are an unemancipated minor, we will release the information to your personal
representative or parent(s) as required by law.
Family/Friends. We may disclose your health
information to a family member or friend to the extent necessary to help
with your healthcare or with payment for your healthcare if you agree that
we may do so. If you wish to designate a person(s) to whom we may discuss
your healthcare, you may submit a request to the address listed below. If
you are physically or mentally unable to participate in decisions regarding
your healthcare, we may need to communicate with a family member; however,
only to the extent necessary to insure that you receive appropriate healthcare
treatment.
Permitted or Required by Law. We must disclose
protected health information about you when required to do so by law. Information
about you may be used or disclosed to regulatory agencies, such as Medicare
and Medicaid; for administrative or judicial hearings; public health authorities;
or law enforcement officials, such as to comply with a court order or subpoena.
Member Authorization
Other uses or disclosures of your protected health information
will be made only with your written authorization, unless otherwise permitted
or required by law. You may revoke an authorization at any time in writing,
except to the extent that we have already taken action on the information
disclosed or if we are permitted by law to use the information to contest
a claim or coverage under the Plan.
Your Rights Regarding Your Protected Health Information
You have the following rights regarding protected health
information that the Plan maintains about you. If you wish to exercise any
of these rights, you may submit your request in writing.
- Right to Access Your Protected Health Information.
You have the right to inspect and/or obtain a copy of individual protected
health information that we maintain about you. We may charge a fee for
the costs of producing, copying and mailing your requested information,
but we will tell you the cost in advance.
- Right to Amend Your Protected Health Information.
You have the right to request an amendment of individual protected health
information that we maintain about you. All requests must be in writing
and must include the reason for the change.
- Right to an Accounting of Disclosures by the Plan.
You have the right to request an accounting of disclosures of individual
protected health information made by the Plan on or after the compliance
date of April 14, 2003. All requests must be in writing and must state
the period of time for which you want the accounting. We may charge
for providing the accounting, but we will tell you the cost in advance.
- Right to Request Restrictions on the Use and Disclosure
of Your Protected Health Information. You have the right to
request that the Plan restricts the use and disclosure of your protected
health information for treatment, payment, or healthcare operations.
The Plan is not required to agree to the requested restriction; however,
if the Plan does agree to the restriction, it must comply with your
request unless the information is needed for an emergency.
- Right to Receive Confidential Communications. You
have the right to request to receive communication of protected health
information from the Plan through an alternative procedure (other than
the standard means of communicating protected health information). All
requests must be in writing and are subject to technical feasibility
for the Plan.
- Right to a Paper Copy of This Notice. You have
the right at any time to receive a paper copy of this Notice, even if
you had previously agreed to receive an electronic copy.
Changes
The Plan reserves the right to change the terms of this
Notice at any time, effective for protected health information that we already
have about you as well as any information that we receive in the future.
We are required by law to comply with whatever Notice is currently in effect.
We will communicate changes to our Notice through subscriber newsletters,
direct mail and/or our Internet website (www.mercyhealthplans.com).
Complaints
If you believe your privacy rights have been violated, you
have the right to file a complaint with the Plan and/or with the federal
government. Complaints to the Plan may be directed to the appropriate Member
Services department listed at the end of this Notice or by calling the Member
Services number listed on the back of your ID card. You may also file a
complaint anonymously by calling the Plan’s Fraud and Abuse Hotline at 1-877-349-5997.
Complaints to the government may be sent to: Secretary of the Department
of Health and Human Services, 200 Independence Avenue, S.W., Washington,
D.C. 20201. You will not be penalized for filing a complaint.
Contact the Plan
If you want more information about this Notice, how to exercise
your rights, or how to file a complaint, please direct your correspondence
to the appropriate Member Services department listed at the end of this
Notice or call the Member Services phone number listed on the back of your
ID card. You can also contact us through our Internet website (www.mercyhealthplans.com).
Arkansas Region
For members in:
- Mercy Health Plans (Commercial)
- Mercy MedicareADVANTAGE PPO (Medicare)
- MercyOne (Individual)
ATTN: Member Services
521 President Clinton Ave.
Little Rock, AR 72201
Missouri (Eastern) Region
(includes St. Louis, Illinois & mid-Missouri)
For members in:
- Mercy Health Plans of Missouri, Inc. (Commercial)
- Mercy Health Plans (Commercial)
- Mercy MedicareADVANTAGE HMO & PPO (Medicare)
- MercyOne (Individual)
ATTN: Member Services
14528 South Outer Forty Road
Suite 300
Chesterfield, MO 63017
Missouri (Southwest) Region
(includes Springfield, Joplin & Southwest Missouri)
For members in:
- Mercy Health Plans of Missouri, Inc. (Commercial)
- Mercy Health Plans (Commercial)
- Mercy MedicareADVANTAGE HMO & PPO (Medicare)
- MercyOne (Individual)
ATTN: Member Services
4520 South National
Springfield, MO 65810
Texas Region
For members in:
- Mercy Health Plans, Laredo (Commercial)
- Texas CHIP Program
ATTN: Member Services
5901 McPherson Suite 20
Suites 1 & 2B
Laredo, TX 78041
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