Privacy Policy
Notice of Privacy Practices
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INORMATION. PLEASE REVIEW IT CAREFULLY. NO ACTION IS REQUIRED ON YOUR PART.
OUR PRIVACY PRACTICES
This notice describes Physicians of Southwest Washington’s (PSW) privacy practices for both current and former member. It explains how we use health information about you and when we may share that health information with others. It also informs you about your right with respect to your health information and how you may exercise these rights. We are required by law to maintain the privacy of your health information and to send you a copy of this policy so that you are aware of how we maintain your privacy.
PSW employees are required to comply with our policies and procedures to protect the confidentiality of health information. Any employee who violates our privacy policy is subject to a disciplinary process.
Employee access to health information is limited on a business “need to know†basis, such as: to make benefit determinations, pay claims, manage care, underwrite coverage, perform quality assessment measurements, administer a plan or provide customer service.
PSW maintains physical, electronic and process safeguards that restrict unauthorized access to your health information. Such safeguards include secured office facilities, locked file cabinets, and controlled computer network systems and password accounts.
Please share this notice with everyone covered by your policy or contract. You have a right to receive a copy of this notice upon request at anytime. If you would like additional copies of the notice or have questions related to the information contained within the notice, please call PSW at (360) 943-4337. You may also view a copy of this notice on our Web site at http://www.pswipa.com/
Should any of our privacy practices change, we reserve the right to change the terms of this notice and to make the new notice effective for all health information that we maintain. We will provide you a copy of the revised notice and post the revised notice on our Web site.
HEALTH CARE INFORMATION MAINTAINED AT PSW
When we refer to “information†or “health information†in this notice, we mean information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health and related health care services. Health information may be transmitted or shared in any form or medium (oral, written or electronic).
The health information we receive may vary by product; therefore, the examples that follow may not apply to all members, but are designed to represent the general categories of information that may be received and maintained by PSW.
- Information provided by you on applications, forms, surveys and our Web sites, such as your name, address and date of birth.
- Information from physicians, hospitals or other health care providers, clinics, medical groups or health care service plans.
- Information provided by your employer, benefits plan sponsor or association, regarding any group product that you may have.
- Information about your transactions and experiences with our affiliates, others, and us, such as products or services purchased, account balances, payment history, claims history, policy coverage and premiums.
- Information from consumer or medical reporting agencies or other third parties, including medical and demographic information.
HOW WE MAY USE OR SHARE YOUR INFORMATION
The following categories describe how we may use and share your health information. For each category we provide examples that help illustrate each type of use or disclosure. Not every use or disclosure in a category will be listed. However, the ways in which we are permitted to use and share health information will fall into one of these categories.
For Treatment
We may share health information with your doctors or hospitals to help them provide medical care for you. For example, if you are hospitalized, we may allow the hospital staff access to any medical records sent to us by your doctor.
We may also use or share your health information with others to help coordinate and manage your health care. For example, we may talk to your doctor to suggest a disease management or wellness program that can help improve your health.
For Payment
We may use your health information when paying your medical bills submitted to us by you or your health care providers, such as doctors and hospitals. Examples of payment activities include billing, claims management and other related administrative functions.
For Health Care Operations
We may use or share certain health information for necessary health care operations. Examples of health care operations include the following:
- Performing quality assessment and improvement activities;
- Evaluatiing provider and health plan performance;
- Providing underwriting coverage;
- Conducting or arranging medical reviews to determine medical necessity, level of care or justification of services;
- Performing auditing functions;