Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

In this notice we use the terms “we,” “us,” and “our” to describe Bright Heart Health. For more details, please refer to section IV of this notice.

  1. WHAT IS “PROTECTED HEALTH INFORMATION”?

Your protected health information (PHI) is individually identifiable health information, including demographic information, about your past, present or future physical or mental health or condition, health care services you receive, and past, present or future payment for your health care. Demographic information means information such as your name, social security number, address, and date of birth. PHI also includes race/ethnicity, language, gender identity, sexual orientation, and pronoun data.

PHI may be in oral, written or electronic form. Examples of PHI include your medical record, claims record, enrollment or disenrollment information, and communications between you and your health care provider about your care.

If your PHI is de-identified in accordance with HIPAA standards, it is no longer PHI.

If you are a an employee of Bright Heart Health, PHI does not include the health information in your employment records.

  1. ABOUT OUR RESPONSIBILITY TO PROTECT YOUR PHI

By law, we must

  1. protect the privacy of your PHI;
  2. tell you about your rights and our legal duties with respect to your PHI;
  3. notify you if there is a breach of your unsecured PHI; and
  4. tell you about our privacy practices and follow our notice currently in effect.

We take these responsibilities seriously and, have put in place administrative safeguards, technical safeguards (such as encryption and passwords), and physical safeguards to protect your PHI and, we will continue to take appropriate steps to safeguard the privacy of your PHI.

III. YOUR RIGHTS REGARDING YOUR PHI

This section tells you about your rights regarding your PHI and describes how you can exercise these rights.

Your right to access and amend your PHI

Subject to certain exceptions, you have the right to view or get a copy of your PHI that we maintain in records relating to your care or decisions about your care or payment for your care. Subject to certain exceptions, requests must be in writing. We may charge you a reasonable, cost-based fee for the copies, summary or explanation of your PHI.

If we do not have the record you asked for but we know who does, we will tell you who to contact to request it. In limited situations, we may deny some or all of your request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have our denial reviewed.

If you believe there is a mistake in your PHI or that important information is missing, you may request that we correct or add to the record. Requests must be in writing, tell us what corrections or additions you are requesting, and why the corrections or additions should be made. We will respond in writing after reviewing your request. If we approve your request we will make the correction or addition to your PHI. If we deny your request, we will tell you why and explain your right to file a written statement of disagreement. Your statement must be limited to 250 words for each item in your record that you believe is incorrect or incomplete. You must clearly tell us in writing if you want us to include your statement in future disclosures we make of that part of your record. We may include a summary instead of your statement.

Submit all written requests to the Bright Heart Health at Quality Department PO Box 103708 Pasadena, CA 91189.

Your right to choose how we send PHI to you or someone else

You may ask us to send your PHI to you at a different address (for example, your work address) or by different means (for example, fax instead of regular mail).

If your PHI is stored electronically, you may request a copy of the records in an electronic format offered by Bright Heart Health. You may also make a specific written request to Bright Heart Health to transmit a copy of your PHI to a designated third party. We may charge a reasonable, cost-based fee.

Your right to receive confidential communications

You have the right to request that we communicate with you about health matters at an alternative mailing address, email address, or telephone number.

If you do not designate an alternative address, we will send all communication related to your receipt of sensitive services in your name at the address or telephone number on file.

Communications subject to this paragraph shall include, but is not limited to the following written, verbal, or electronic communications:

  • Bills and attempts to collect payment.
  • The name and address of a provider, description of services provided, and other information related to care.
  • Any written, oral, or electronic communication from a health insurer that contains protected health information.

To provide a confidential address for receipt of confidential communications, Submit all requests in writing to Bright Heart Health at Quality Department PO Box 103708 Pasadena, CA 91189.

Your right to an accounting of disclosures of PHI

You may ask us for a list of our disclosures of your PHI. You are entitled to one disclosure accounting in any 12-month period at no charge. If you request any additional accountings less than 12 months later, we may charge a fee.

To request an accounting, submit all requests in writing to Bright Heart Health at Quality Department PO Box 103708 Pasadena, CA 91189.

An accounting does not include certain disclosures, for example, disclosures:

  • to carry out treatment, payment and health care operations;
  • for which Bright Heart Health had a signed authorization;
  • of your PHI to you;
  • internally within Bright Heart Health;
  • for notifications for disaster relief purposes;
  • to persons involved in your care and persons acting on your behalf; or
  • not covered by the right to an accounting.

Your right to request limits on uses and disclosures of your PHI

You may request that we limit our uses and disclosures of your PHI for treatment, payment, and health care operations purposes. We will review and consider your request.

To request a limit on uses and disclosures, submit all requests in writing to Bright Heart Health at Quality Department PO Box 103708 Pasadena, CA 91189.

We will honor your request to the extent required by law. We cannot restrict disclosure to a health plan or insurer for payment or health care operations purposes. For requests to restrict your PHI for payment or health care operations purposes, please request the restriction prior to receiving services from Bright Heart Health.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say ‘no’ if it would affect your care. We will consider all submitted requests and, if we deny your request, we will notify you in writing.

Your right to receive a paper copy of this notice

You also have a right to receive a paper copy of this notice upon request.

  1. BRIGHT HEART HEALTH SUBJECT TO THIS NOTICE

This notice applies to the Bright Heart Health, Inc. and Bright Heart Health Medical Group.

To provide you with the health care you expect, to treat you, to pay for your care, and to conduct our operations, such as quality assurance, accreditation, licensing and compliance, these Bright Heart Health companies share your PHI with each other.

Our personnel may have access to your PHI either as employees, physicians, professional staff members and others authorized to enter information into our data systems.

  1. HOW WE MAY USE AND DISCLOSE YOUR PHI

Your confidentiality is important to us. Our medical providers and employees are required to maintain the confidentiality of the PHI of our members/patients, and we have policies and procedures and other safeguards to help protect your PHI from improper use and disclosure. Sometimes we are allowed by law to use and disclose certain PHI without your written permission. We briefly describe these uses and disclosures below and give you some examples.

How much PHI is used or disclosed without your written permission will vary depending, for example, on the intended purpose of the use or disclosure. Sometimes we may only need to use or disclose a limited amount of PHI, such as to send you an appointment reminder or to confirm that you are a health plan member. At other times, we may need to use or disclose more PHI such as when we are providing medical treatment.

Treatment: This is the most important use and disclosure of your PHI. For example, our physicians, nurses, and other health care personnel, including trainees, involved in your care use and disclose your PHI to diagnose your condition and evaluate your health care needs. Our personnel will use and disclose your PHI in order to provide and coordinate the care and services you need. If you need care from health care providers who are not part of Bright Heart Health, such as community resources to assist with your health care needs at home, we may disclose your PHI to them.

Payment: Your PHI may be needed to determine our responsibility to pay for, or to permit us to bill and collect payment for, treatment and health-related services that you receive. For example, we may have an obligation to pay for health care you receive from an outside provider. When you or the provider sends us the bill for health care services, we use and disclose your PHI to determine how much, if any, of the bill we are responsible for paying.

Health care operations: We may use and disclose your PHI for certain health care operations—for example, quality assessment and improvement, training and evaluation of health care professionals, licensing, accreditation, and determining other costs of providing health care.

Business associates: We may contract with business associates to perform certain functions or activities on our behalf, such as payment and health care operations. These business associates must agree to safeguard your PHI.

Appointment reminders: We may use your PHI to contact you about appointments for treatment or other health care you may need.

Identity verification: We may photograph you for identification purposes, storing the photo in your medical record. This is for your protection and safety, and as required by the law.

Health Information Exchange: We may share your health information electronically with other organizations through a Health Information Exchange (HIE) network. These other organizations may include hospitals, laboratories, health care providers, public health departments, health plans, and other participants. Sharing information electronically is a faster way to get your health information to the health care providers treating you. For example, if you go to a hospital emergency room that participates in the same HIE network as Bright Heart Health, the emergency room physicians would be able to access your Bright Heart Health health information to help make treatment decisions for you. HIE participants like Bright Heart Health are required to meet rules that protect the privacy and security of your health and personal information.

If your medical record contains certain information (such as from a substance use disorder program) that requires your authorization under state or federal law before information is shared, then Bright Heart Health will not release that information to your other treating providers through HIE until you provide authorization.

Specific types of PHI: There are stricter requirements for use and disclosure of some types of PHI—for example, mental health and drug and alcohol abuse patient information, HIV tests, and genetic testing information. However, there are still circumstances in which these types of information may be used or disclosed without your authorization.

For example, the confidentiality of substance use disorder patient records we maintain may also be protected by the federal Confidentiality of Substance Use Disorder Treatment Records, 42 U.S.C. § 290dd-2, 42 C.F.R. Part 2 (“Part 2”). To the extent that Part 2 governs one of our programs, our use and disclosure of any of your PHI that is covered under Part 2 will be done only as permitted by Part 2, as further described below.

Federal law permits us to disclose your Part 2 PHI without your prior written consent as follows:

  • Pursuant to an agreement (requiring compliance with Part 2) with a qualified service organization/ business associate that provides services to us;
  • To qualified personnel for purposes of research, audit or program evaluation;
  • To report a crime committed by you on our facility’s premises or against our personnel or any threat to commit such a crime;
  • To medical personnel in a medical emergency;
  • To appropriate authorities to report suspected child abuse and/or neglect; and
  • As allowed by a court order that is in compliance with the Part 2 requirements for court orders.

If you are receiving treatment covered by Part 2, we may not say to a person outside the program that you attend the program, nor disclose any information identifying you as having or having had a substance use disorder or disclose any other protected information except as permitted by Part 2 or with your written consent. In addition, if applicable, Part 2 requires us to obtain your written consent before we can disclose information about you for payment purposes. For example, we must obtain your written consent before we can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before we can share information for treatment purposes outside the program or for health care operations. A violation of Part 2 by a program is a crime, and suspected violations may be reported to appropriate authorities in accordance with Part 2, along with contact information.

Underwriting: We may use and disclose your PHI, to the extent permitted under applicable law, for underwriting purposes, including the determination of benefit eligibility and costs of coverage and to perform other activities related to issuing a benefit policy. However, we exclude from review or disclosure for underwriting purposes, genetic information, race/ethnicity, language, gender identity, sexual orientation, and pronoun data. Your genetic information includes information about your genetic tests, your family members’ genetic tests, and requests for or receipt of genetic services by you or any family members.

Communications with family and others when you are present: Sometimes a family member or other person involved in your care will be present when we are discussing your PHI with you. If you object, please tell us and we won’t discuss your PHI, or we will ask the person to leave.

Communications with family and others when you are not present: There may be times when it is necessary to disclose your PHI to a family member or other person involved in your care because there is an emergency, you are not present, or you lack the decision-making capacity to agree or object. In those instances, we will use our professional judgment to determine if it’s in your best interest to disclose your PHI. If so, we will limit the disclosure to the PHI that is directly relevant to the person’s involvement with your health care.

Disclosure in case of disaster relief: We may disclose your name, city of residence, age, gender, and general condition to a public or private disaster relief organization to assist disaster relief efforts, unless you object at the time.

Research: If permitted by law, we may share your PHI for research purposes. .

Organ donation: We may use or disclose PHI to organ-procurement organizations to assist with organ, eye, or other tissue donations.

Public health activities: Public health activities cover many functions performed or authorized by government agencies to promote and protect the public’s health and may require us to disclose your PHI.

For example, we may disclose your PHI as part of our obligation to report to public health authorities’ certain diseases, injuries, conditions, and vital events such as births. Sometimes we may disclose your PHI to someone you may have exposed to a communicable disease or who may otherwise be at risk of getting or spreading the disease.

The Food and Drug Administration (FDA) is responsible for tracking and monitoring certain medical products, such as pacemakers and hip replacements, to identify product problems and failures and injuries they may have caused. If you have received one of these products, we may use and disclose your PHI to the FDA or other authorized persons or organizations, such as the maker of the product.

We may use and disclose your PHI as necessary to comply with federal and state laws that govern workplace safety.

Health oversight: As health care providers and health plans, we are subject to oversight conducted by federal and state agencies. These agencies may conduct audits of our operations and activities and in that process, they may review your PHI.

Disclosures to your employer or your employee organization: If you are enrolled with Bright Heart Health through your employer or employee organization, we may share certain PHI with them without your authorization, but only when allowed by law. For example, we may disclose your PHI for a workers’ compensation claim or to determine whether you are enrolled in the plan or whether premiums have been paid on your behalf. For other purposes, such as for inquiries by your employer or employee organization on your behalf, we will obtain your authorization, when necessary under applicable law.

Workers’ compensation: We may use and disclose your PHI in order to comply with workers’ compensation laws. For example, we may communicate your medical information regarding a work-related injury or illness to claims administrators, insurance carriers, and others responsible for evaluating your claim for workers’ compensation benefits.

Military activity and national security: We may sometimes use or disclose the PHI of armed forces personnel to the applicable military authorities when they believe it is necessary to properly carry out military missions. We may also disclose your PHI to authorized federal officials as necessary for national security and intelligence activities or for protection of the president and other government officials and dignitaries.

Required by law: In some circumstances federal or state law requires that we disclose your PHI to others. For example, the secretary of the Department of Health and Human Services may review our compliance efforts, which may include seeing your PHI.

Lawsuits and other legal disputes: We may use and disclose PHI in responding to a court or administrative order, a subpoena, or a discovery request. We may also use and disclose PHI to the extent permitted by law without your authorization, for example, to defend a lawsuit or arbitration.

Law enforcement: We may disclose PHI to authorized officials for law enforcement purposes, for example, to respond to a search warrant, report a crime on our premises, or help identify or locate someone.

Serious threat to health or safety: We may use and disclose your PHI if we believe it is necessary to avoid a serious threat to your health or safety or to someone else’s.

Abuse or neglect: By law, we may disclose PHI to the appropriate authority to report suspected child abuse or neglect or to identify suspected victims of abuse, neglect, or domestic violence.

Coroners and funeral directors: We may disclose PHI to a coroner or medical examiner to permit identification of a body, determine cause of death, or for other official duties. We may also disclose PHI to funeral directors.

Inmates: Under the federal law that requires us to give you this notice, inmates do not have the same rights to control their PHI as other individuals. If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your PHI to the correctional institution or the law enforcement official for certain purposes, for example, to protect your health or safety or someone else’s.

De-Identification: We or a business associate with whom we have contracted may use PHI to de-identify it in accordance with HIPAA standards and may further disclose the de-identified data to third parties in connection with our operations.

  1. ALL OTHER USES AND DISCLOSURES OF YOUR PHI REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION

Except for those uses and disclosures described above, we will not use or disclose your PHI without your written authorization. Some instances in which we may request your authorization for use or disclosure of PHI are:

Marketing: We may ask for your authorization in order to provide information about products and services that you may be interested in purchasing or using. Note that marketing communications do not include our contacting you with information about treatment alternatives, prescription drugs you are taking or health-related products or services that we offer. Marketing also does not include any face-to-face discussions you may have with your providers about products or services.

Sale of PHI: We may only sell your PHI if we received your prior written authorization to do so.

Psychotherapy Notes: On rare occasions, we may ask for your authorization to use and disclose “psychotherapy notes”. Federal privacy law defines “psychotherapy notes” very specifically to mean notes made by a mental health professional recording conversations during private or group counseling sessions that are maintained separately from the rest of your medical record.

When your authorization is required and you authorize us to use or disclose your PHI for some purpose, you may revoke that authorization by notifying us in writing at any time. Please note that the revocation will not apply to any authorized use or disclosure of your PHI that took place before we received your revocation.

VII. HOW TO CONTACT US ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you have any questions about this notice or want to lodge a complaint about our privacy practices, please write to Member Services at Bright Heart Health PO Box 103708 Pasadena, CA 91189 or let us know by calling us at 1-800-892-2695. You also may notify the secretary of the Department of Health and Human Services.

We will not take retaliatory action against you if you file a complaint about our privacy practices.

VIII. CHANGES TO THIS NOTICE

We may change this notice and our privacy practices at any time, as long as the change is consistent with state and federal law. Any revised notice will apply both to the PHI we already have about you at the time of the change, and any PHI created or received after the change takes effect. If we make an important change to our privacy practices, we will promptly change this notice and make the new notice available on our Web site. Except for changes required by law, we will not implement an important change to our privacy practices before we revise this notice.

  1. EFFECTIVE DATE OF THIS NOTICE

This notice is effective on May 31, 2024.

  1. SUPPLEMENTAL NOTICES

If you believe your privacy rights have been violated, you may file a complaint with the Plan or with the Secretary of the Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with the Plan, contact the Privacy Contact identified in this Notice.

To file a complaint with the Secretary of the Department of Health and Human Services Office for Civil rights use this contact information:

U.S. Department of Health and Human Services

200 Independence Avenue SW.

Room 509F, HHH Building

Washington, DC 20201

1–800–368–1019, 800–537–7697 (TDD)

File complaint electronically at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html