- We must keep your information from others who
do not need to know it.
- You need to tell us what information we can share
and when we can share it.
Who sees my information? Your information is
only provided to the programs you list. We will not
share information with any other programs unless you
ask us to do so.
What about my Medical Information? Healthcare
providers who take care of you may use your private
medical information. This may cover health care you
had before now, or may have later on.
What all is Shared? We only share information
about you that is needed at that time by that provider
or agency to do their job.
How is Insurance Billed? Your healthcare provider
sends a bill to an insurance company or to a government
program to get paid, if applicable.
May I See my Medical Information? You are allowed
to see your medical information. Most of the time you
can receive a copy if you ask. You may ask for a list
of any places where medical information may have been
sent if it was not sent as part of your provider’s
care or used to be sure that you received quality care
and that all laws about medical care are met.
What if my Medical Information needs to go Somewhere
Else? You will be asked to sign an authorization
form allowing your medical information to be shared
if:
- Your healthcare provider needs to send it to other
places;
- You want us to send it to another healthcare provider;
or,
- You want it sent to another person for you.
The form tells us what, where and to whom the information
must be sent.
Your authorization is good for 6 months or until the
date you put on the form. You can cancel or limit the
amount of information sent at any time by letting us
know in writing.
Note: If you are less than 18 years old,
your parents or guardians will receive your private
medical information, unless you are able to consent
for your own healthcare treatment. If you are, then
it will not be shared with your parents or guardians
unless you sign an authorization form.
Could Medical Information be Released Without my
Authorization? There are laws that tell us when
we have to release private medical information, even
if you do not sign an authorization form. We always
report:
- Contagious diseases;
- Reactions and problems with treatments;
- To the police when they are investigating a crime,
when child or elderly abuse may be happening, or
when the court orders us to;
- To the government to review how the Medicaid program
is working;
- To a provider or other insurance who needs to
know if you have Medicaid;
- Work related injuries to workers compensation;
- To the Federal Government when they are investigating
something important to protect our country, the
President and other government workers.
May I Have a Copy of This Notice? This notice
is yours. If anything changes, you will get a new one.
If you have any questions about this notice, please
ask the person who gave it to you. If there are questions
that cannot be answered, you can call the State Department
of Human Rights Commission at 615-741-5825. You can
complain to the Secretary of Health and Human Services
of the Federal Government by writing to 200 Independence
Ave. SW, Washington, DC 20201. You need to do with within
180 days of when the problem that concern happened.
You could also complain to the Office for Civil Rights
by calling 866-627-7748.
Your Medicaid benefits will not be affected by
a complaint made to the State Privacy Official or
to the Secretary of Health and Human Services.
