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Privacy

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice”) contains important information regarding your health information. Our current Notice is posted at www.modifyhealth.com/pages/privacy You also have the right to receive a paper copy of this Notice and may ask us to give you a copy of this Notice at any time. If you received this Notice electronically, you are entitled to a paper copy of this Notice. If you have any questions about this Notice please contact the person listed in Section 5, below.

This Notice describes how theModify Health Program(the “Program”), and any third party that assists in the administration of the Program, may use and disclose your health information for treatment, payment, or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your health information. “Health information” is information that is maintained or transmitted by the Program, which may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

We understand that health information about you and your health is personal. We are committed to protecting health information about you and will use it to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request of it. This Notice applies to all of the medical records we maintain. Your personal doctor or health care provider may have different policies or notices regarding their use and disclosure of your health information.

It is important to note that these rules apply to the Program, not Modify Health LLC as an employer.

  1. How We May Use and Disclose Health information About You. Absent explicit instructions from you to the contrary, Modify Health may generally use and disclose your health information without your permission for purposes of health care treatment, payment activities, and health care operations. These uses and disclosures are more fully described below. Please note that this Notice does not list every use or disclosure; instead it gives examples of the most common uses and disclosures.
  • Treatment: When and as appropriate, we may use or disclose health information about you to facilitate medical treatment or services by providers. We may disclose health information about you to health care providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.

  • Payment: When and as appropriate, we may use and disclose health information about you to determine your eligibility for the Program’s benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility and coverage under the Program, or to coordinate your coverage.

  • Health Care Operations: When and as appropriate, we may use and disclose health information about you for the Program’s operations, as needed. For example, we may use your health information in connection with: conducting quality assessment and administration improvement; business planning and development such as cost management; and business management and general administrative activities of the Program. For example, we may use your information to review the effectiveness of the Programs or in negotiating new arrangements with insurers.

OTHER PERMITTED USES AND DISCLOSURES

  • Disclosure to Others Involved in Your Care: We may disclose health information about you to your physician, or to any other person you identify, provided the information is directly relevant to that person’s involvement with your health care.

  • To Comply with Federal and State Requirements: We will disclose health information about you when required to do so by federal, state, or local law. For example, we may disclose health information when required by the U.S. Department of Labor or other government agencies that regulate us; to federal, state, and local law enforcement officials; in response to a judicial order, subpoena, or other lawful process; and to address matters of public interest as required or permitted by law. We are required to disclose health information about you to the Secretary of the U.S. Department of Health and Human Services if the Secretary is investigating or determining compliance with HIPAA, or to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. We may disclose your health information to a health oversight agency for activities authorized by law (such as audits, investigations, inspections, and licensure).

  • Business Associates: We may disclose your health information to our business associates. We have contracted with entities to help us administer the Program. We will enter into contracts with these entities requiring them to only use and disclose your health information as we are permitted to do so.

  • Other Uses: If you are an organ donor, we may release your health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. We may release your health information to a coroner or medical examiner. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your information to the correctional institution or law enforcement official.

Uses and disclosures other than those described in this Notice will require your written authorization.You may revoke your authorization at any time, but you cannot revoke your authorization if the Program has already acted on it.

The privacy laws of a particular state or other federal laws might impose a more stringent privacy standard. If these more stringent laws apply and are not superseded by federal preemption rules, the Program will comply with the more stringent law.

  1. Your Rights Regarding Health Information About You. You have the following rights regarding health information that we maintain about you:
  • Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your benefits under the Program.

If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. If the Program does not maintain the health information, but knows where it is maintained, you will be informed of where to direct your request.

  • Your Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Program.

You also must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend any of the following information:

  • Information that is not part of the health information kept by or for the Program.
  • Information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
  • Information that is not part of the information which you would be permitted to inspect and copy.
  • Information that is accurate and complete.

You must make any of the requests described above, to the person listed in Section 5, below.

  1. Changes to This Notice. We can change the terms of this Notice at any time. If we do, the new terms and policies will be effective for all of the health information we already have about you as well as any information we receive in the future. We will send you a copy of the revised notice.

  2. Other Uses of Health information. Other uses and disclosures of health information that are not covered by this Notice or the laws that apply to us will be made only with your written permission. If you grant us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.

  3. Contact Information. All correspondence relating to the contents of this Notice should be directed as follows:

Attn: Greg Comrie, Privacy Officer
190 Bluegrass Valley Parkway
Alpharetta, Georgia 30005
858-766-3439


The effective date of this Notice is June 14, 2019.