Notice of Privacy Practices

• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• We may say “no” to your request for certain types of records, such as psychotherapy notes, or information for use in civil, criminal, or administrative actions. If we deny your request, we will tell you the reason why in writing.
• You may have the right to have a licensed health care professional review the denial. We will let you know if this right is available.

• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. You must make your request in writing. Ask us how to do this.
• We may say “no” to your request, but we will tell you why in writing within 60 days.
• If your request is denied, you have the right to send us a statement to include in the record.

• You can ask us to contact you in a specific way (for example, using your home or work phone) or to send mail to a different address. Ask us how to do this.
• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

• You can ask us not to use or share certain health information
• We are not required to agree to your request, and we may say “no” if it would affect your care.
• We are required to agree to your request, if you ask us not to share information with a health plan if you or someone else, other than the health plan, have paid for the care in full and when the disclosure is not required by law.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make, or those required by law). We will provide one accounting a year for free but may charge a reasonable cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
• You can also find this notice on our website at
  https://thealliance.health/

• If you have given someone medical power of attorney, if someone is your legal guardian, or if you have given us written authorization to act as your personal representative, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel your rights are violated by contacting us at the information in the “Our Responsibilities” section on page 5 of this notice.

• You can also file a complaint with the Department of Healthcare Services (DHCS), and the U.S. Department of Health and Human Services Office for Civil Rights.

In the cases where you can tell us your choices about what we share, you have the right to tell us to:

Share information in a disaster relief situation.

Contact you for fundraising efforts.

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

Sale of your information.

Psychotherapy notes.

Substance abuse treatment records.

Help manage the health care treatment you receive

• We can use your health information and share it with professionals who are treating you.

• We can use and disclose your information to run our organization and contact you when necessary.

• We can also use and disclose your information to contractors (Business Associates) who help us with certain functions. They must sign an agreement to keep your information confidential before we share it with them.

• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.

Example: We share your name and address with a contractor to print and mail our member identification cards.

Pay for your health services

• We can use and disclose your health information as we pay for your health services.

• We may disclose your health information to your health plan sponsor for plan administration.

Help with public health and safety issues

• We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety.

Health Information Exchange (HIE)

• We participate in health information exchanges (HIEs), which allow providers to coordinate care and provide faster access to our members. HIEs can also assist providers and public health officials in:

  • making more informed decisions;

  • avoiding duplicate care (such as tests); and,

  • reducing likelihood of medical errors.

• If you don’t want us to share your health information in this way, you can notify us by completing the HIE Member Opt Out Form for PHI.

Do research

• We can use or share your information for health research.

Comply with the law

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

• We can share information about you with organ procurement organizations.

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

• We can use or share health information about you:

• For workers’ compensation claims.

• For law enforcement purposes or with a law enforcement official.

• With health oversight agencies for activities authorized by law.

• For special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.