Notice of Privacy Practices

This notice describes how medical information about you may be used and shared and how you can get access to this information. Please review it carefully.

Health Choice Utah (Health Choice) is your health plan. When you enrolled with Health Choice and were assigned to our plan, we received information about you. We get information about you from your doctor, hospital, dentist, and other providers that you see so that we can pay your medical bills. We know that the information about you is very personal. The laws say that:

We must keep your information from others who do not need to know it.
We must give you this Notice that explains our privacy practices and how we handle the medical information we have about you, and
We must do all of the things that we talk about in this notice.

Uses and disclosures for payment and health care operations. When you enroll for Medicaid, you let the Utah Department of Health (UDOH) and your health plan use and share medical information about you so that we can pay your medical bills. We may also use and share medical information about you so that we can set up your medical care as well as make sure you get the best health care possible. We also have to share your health information with the UDOH so that they can run the Medicaid Program. Your medical information may be used or shared without your permission for reasons like:

Enrollment and disenrollment in Health Choice;
Paying your medical bills;
Member Service calls;
Speaking to your providers (for example: doctors, hospitals, and dentists) about your care and giving them medical information about you that will help them treat you;
Our review of our own programs;
Reviewing information from providers for treatment requests, grievances, fraud and abuse;
Reviewing your medical chart to make sure you are getting the best health care possible;
Medical case management;
Working with other agencies that provide health care services to you;
Reporting to the UDOH and answering requests from the UDOH.

It is important for you to know that we use only the health information about you that we need to do our job. Only those people in Health Choice that have a need to see your information are able to see and use it. When we share your health information that the law allows us to, we only share the information that the person needs to do their job. We believe that your privacy is very important.

Health-related benefits or services. From time to time, Health Choice may use and share your medical information so that we may to tell you about benefits or services that you might be interested in.

Disclosures required by law. Health Choice will share medical information about you when federal, state, or local law tells us that we have to.

Health oversight activities. Health Choice may share medical information with the UDOH or the Federal Centers for Medicare and Medicaid (CMS). This could include things like audits, investigations, and inspections. These activities are necessary so that the government may review the health care system and how you get health care.

Lawsuits and disputes. If you are involved in a lawsuit or a grievance, we may share medical information about you to respond to a court order or an order from the Administrative Hearing Courts. We may also share medical information about you to respond to a lawful process (for example, a subpoena or discovery request). In this case, we will not share any information unless we know that the person asking for the information has tried to let you know that they are going to ask for it.

Law enforcement. Health Choice may have to give a law enforcement official medical information about you. In rare cases, we may have to share information about you because of national security.

Written permission (Authorization). Other uses and disclosures of your medical information that are not mentioned in this notice or not allowed by the law will be made only with your written permission. You will tell us what information we may share, where and to whom the information must be sent. Your authorization is good until the date you put on the form. You can take back or limit the amount of information sent at any time by letting us know in writing. If you take back your permission, we will no longer use or share medical information about you for the reasons covered by your authorization.

Note: If you are less than 18 years old, your parents or guardians will get your private medical information, unless the law allows you to get treatment without the consent of your parent or guardian. If the law allows you to get treatment without the consent of your parent or guardian, then the information about that treatment will not be shared with your parents or guardians unless you sign an authorization form.

Could Health Information Be Released Without My Authorization? There are laws that tell us when we have to share private medical information, even if you do not sign an authorization form. We always report:

To the police when they are investigating a crime, when child or elder abuse may be happening, or when the court orders us to;
To the UDOH or CMS so they can review how the Medicaid program is working;
To a provider or other insurance company who needs to know if you are a Medicaid member;
Work related injuries to workers compensation;
Information about immunizations and lead blood levels to the UDOH;
To the Federal Government when they are investigating something important to protect our country, the President and other government workers.

Your rights regarding your medical information You have the right to look at and copy medical information that may be used to make decisions about your medical care. Usually, this right includes your medical record and the bills that providers send to us. You must send your request to us in writing to the Health Choice Privacy Officer. Your first copy is free. If you request another copy within one year, we may charge a fee for the costs of copying, mailing, or other supplies to meet your request. There may be times when we may deny your request to look at or copy your medical information. If that happens, you have a right to ask us to review our decision to deny your request.

You have the right to request that Health Choice restrict the use of your medical information for treatment services, payments to providers, and for Health Choice's business purposes. You may also ask that we restrict the disclosure of your medical information to your relatives or friends that are involved with your care. We do not have to agree to your request, but if we do agree, we will follow your request unless the information is needed to provide you with emergency treatment. To request restrictions, you must send your request in writing to the Health Choice Privacy Officer and tell us:

What information you want to limit;
Whether you want to limit its use, disclosure, or both;
To whom you want the limits to apply.

You also have the right to request to get information from us at a different address or phone number. To do this, you must send your request in writing to the Health Choice Privacy Officer and specify how and/or where you wish to be contacted.

If you feel that your medical information is incorrect or incomplete, you have the right to request that your medical information be corrected. The health care provider (i.e., doctor, hospital, clinic, etc.) that created your medical information is responsible for amending it. For more information on how to submit a request, contact the Health Choice Privacy Officer or your health care provider.

You have a right to ask for a list of people that we have shared your information with. This is called an Accounting of Disclosures. There are some things that are not on that listing. Examples of this are when you give us permission to give someone your medical information, payments that we have made to your doctors, or those times that we use and share your medical information for our operations and to get paid. To request a list of disclosures, you must send a request in writing to the Health Choice Privacy Officer. Your request must state a time period, which may not be longer than six years prior to the date of your request and may not include dates before April 14, 2003. Your request should indicate the form in which you want the information (for example, paper or by e-mail).

You have the right to a paper copy of this Notice. You may ask for another copy of this Notice at any time. This notice will be available at all times on our website, www.healthchoiceutah.com

We may change this Notice. The changes to the Notice might involve medical information we already have about you, as well as any information we get in the future. If we do change the Notice, we will send you the new one. You will always know which one is the most current because we print the effective date of the Notice on the top of the front page.

Complaints If you believe your privacy rights have been violated and that Health Choice has not followed what we have said in this Notice, you may file a complaint, in writing, with the Health Choice Privacy Officer. The address is at the bottom of this Notice. If we do not answer all of your questions, you may complain to the Secretary of the Department of Health and Human Services. You will never be penalized or discriminated against for filing a complaint.

Questions If you have any questions about this notice, contact the Health Choice Privacy Officer. Your medical treatment providers (i.e., doctors, hospitals, home health agencies, etc.) may have different policies or notices about the use and sharing of your medical information. If you have questions about your provider's privacy policies, please contact your provider directly.

How to contact the Health Choice Privacy Officer:
Health Choice Privacy Officer
410 N. 44th Street, Ste. 900
Phoenix, AZ 85008

1-800-322-8670

Puede obtener una copia de este formulario en español, si la pide.

(Effective Date April 18, 2012)