Member Rights

There are certain times when we may use or disclose your PHI. When we disclosure your PHI, we will comply with any and all requirements surrounding the disclosures, including, but not limited to, those found in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act, (“HITECH”), 42 C.F.R. Part 2, and North Carolina General Statutes Chapter 122C.

We are required to disclose health information about you, under certain circumstances:

To you, or your authorized representative, upon request

To the Secretary of the Department of Health and Human Services, upon request, to determine if we are complying with the Privacy Rule.

For Treatment Purposes

We may use and disclose your PHI to coordinate, and/or manage your healthcare and related services. For example, we may use or disclose health information about you when you need a prescription filled, when we consult with another healthcare provider about your care, or to emergency treatment providers when you need emergency services. To the extent any of your PHI includes records covered under 42 C.F.R. Part 2, we will comply with the terms and conditions of those regulations regarding disclosure for treatment purposes.

For Payment Purposes

We may use and disclose your PHI to pay providers for the healthcare services you receive, and determine if appropriate claims are paid. For instance, we may use or disclose health care information about you when auditing a provider’s claims, to determine if the claims submitted are backed by proper documentation. To the extent any of your PHI includes records covered under 42 C.F.R. Part 2, we will comply with the terms and conditions of those regulations regarding disclosure for payment purposes.

To Perform Business Health Care Operations

We may use and disclose you PHI in performing our business activities called “health care operations.” These healthcare operations allow us to improve the quality of care we provide and reduce healthcare costs. For example, we may use or disclose your PHI for internal quality improvement activities. We may also use and disclose your PHI for the healthcare operations of our providers. For example, we may use or disclose health information about you for internal quality improvement activities of a provider that has treated you. To the extent any of your PHI includes records covered under 42 C.F.R. Part 2, we will comply with the terms and conditions of those regulations regarding use or disclosure for healthcare operations purposes.

State and federal laws require or allow that we share your health information with others in specific situations without your consent. Prior to disclosing your health information, we will evaluate each request to ensure that only the minimum necessary information will be disclosed.

We may disclose health information about you for the following reasons. Before we make any disclosures for these reasons, we will ensure any required circumstances for disclosure are met:

If the use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of the law (for instance, as required under North Carolina General Statutes Chapter 122C);

For public health activities, such as for the purpose of preventing or controlling disease;

To report child abuse or neglect to a public health authority or other appropriate government authority authorized by law to receive such reports;

For purpose of activities related to monitoring an FDA-regulated product, to a person subject to the jurisdiction of the FDA;

For health oversight activities, including, but not limited to, civil, administrative, and criminal proceedings;

In response to a court order or subpoena;

For certain law enforcement purposes, such as for the purpose of identifying or locating a suspect or fugitive;

To law enforcement, if you are believed to be the victim of a crime;

To a coroner, for purposes of identifying a deceased person, determining cause of death, or other duties required by law, or to funeral directors so they may carry out their duties;

For organ procurement purposes;

For research purposes;

To avert a serious threat to health or safety;

To determine eligibility for or entitlement to benefits under laws administered by the Secretary of Veterans Affairs;

For certain military, national security, and intelligence purposes;

To a correctional institution or other law enforcement official having lawful custody of an inmate;

For worker’s compensation purposes; or

For eligibility purposes

We will not use or disclose psychotherapy notes without your written authorization, except as allowed or required by law.

We will not market or sell your health information without your written authorization, except as allowed or required by law.

You may revoke a written authorization provided for any of the above purposes at any time; however, the revocation will not apply to any actions we have already taken in reliance on the authorization.

We will not use or disclose your PHI without your written authorization for any purpose not identified in this notice, except as allowed or required by law.

Your PHI will not be disclosed without your authorization, unless allowed or required by law.

You have the right to request, in writing, restrictions on certain uses and disclosures of your health information. We will make reasonable effort to accommodate your request; however, with limited exceptions, we are not required to agree to these restrictions.

If you sign a written authorization allowing us to use and disclose your PHI, you may revoke that authorization at any time. The revocation will be effective as of the date of your revocation and will not apply to any actions we have already taken in reliance on the authorization.

You have the right to request, in writing, to review and receive copies of your PHI. There may be a charge for making copies of your requested health information. There are circumstances where we may be unable to grant your request to review records.

You have the right to request, in writing, to amend existing information that is part of your protected health information. There are certain situations where we will be unable to grant your request to amend your protected health information.

You have the right to request, in writing, a list of certain disclosures we have made regarding your health information. This does not include disclosures we have made for treatment, payment, or healthcare operations purposes, and certain other purposes. Your first request will be provided to you free of charge. However, if you request a list of disclosures more than once in a 12 month period, you may be charged a reasonable fee. We will inform you of the cost incurred and you may choose to withdraw or modify your request at that time, before any costs are incurred. There are certain exceptions that apply.

You have a right to request, in writing, to be contacted at a different address or phone number, or by any other appropriate manner, about your health information.