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.

Managed Health Services
1099 N. Meridian Street, Suite 400
Indianapolis, Indiana 46204

Effective April 4, 2003

PRIVACY NOTICE

This privacy notice applies to MHS and all of its partners including Cenpatico. At MHS, your privacy is important. We will do all we can to protect your health records.

If you need help understanding this notice, please call MHS Member Services at (877) 647-4848; hearing impaired TDD/TTY (800) 743-3333. Language interpreter services are provided free of charge to you as a MHS member.

By law, we must protect your health records and send you this notice.
This notice tells you how we use your health records. It describes when we can share your records with others and when we can not. It explains your rights about the use of your health records. It also tells you how to use those rights and who can see your health records. This notice does not apply to records that do not identify you.

When we talk about your health records in this notice, it means any record of your health services while you are an MHS member. This includes providing healthcare to you. It also includes payment for your care while you are an MHS member.

You will also receive a Privacy Notice from the State of Indiana with its rules for your health records. Other health plans and providers may have differing rules when using or sharing your health records. We ask that you get a copy of their Privacy Notices and read them.

MHS protects your information shared orally/verbally at our offices and in talking with others. Only employees who need it to do their job may see or talk about your information. We have locks and security systems to limit visitors and limit who can visit areas where we keep your information. We do not talk about your health information in common areas such as lunch rooms or elevators. We do not give member information on the phone until we verify it is you, a healthcare provider or other authorized person.

MHS protects your information on paper by keeping it under lock and key.

MHS protects your electronic information (on computers) with passwords, limited access, and other security systems.

How We Use or Share Your Health Records

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• To help us pay the bills your doctors send us.
• To help your doctors give you the right care. If you are in the hospital, we can give the hospital the records your doctor sends us.
• To help manage your health. We might talk to your doctor about a disease or wellness program that could improve your health.
• To help resolve any administrative reviews or grievances filed by you or a doctor with Managed Health Services or the State of Indiana.
• To assist others who help us provide your health services. We will not share your records with these groups unless they agree to protect your records.
• For public health or disaster relief efforts.
• To remind you if you have a doctor’s visit.
• To tell you about other treatments and programs. This could be on how to stop using tobacco products or tips to maintain a healthy weight.
• To design special health programs and services.
State and federal laws may call for us to give your health records to others. This could be for these reasons:
• To state and federal agencies that control us: these agencies include the Indiana Department of Insurance and the Indiana Family and Social Services Administration and the U.S. Centers for Medicare and Medicaid Services.
• For public health actions: for example, the Food and Drug Administration may need to check or track medicines; or, it may need to track medical device problems.
• To public health groups: this is done if we think a serious public health or safety threat exists.
• To a health agency for certain activities: these activities can be audits and inspections; sometimes they are licensure and disciplinary actions.
• To a court or administrative agency: for example, if you sue someone in court because they injured you, we will give the court health records when ordered, but only if efforts have been made to tell you about the request or a court order protects the records requested
• To law enforcement: for example, we may give your records to a law enforcement officer to find someone; such as a suspect or fugitive, someone who is missing, or a material witness.
• To a government person: this could be about child abuse, or it could be about neglect or violence in your home.
• To a coroner or medical examiner to name a dead person, to find the cause of death, or to funeral directors to help with their duties.
• For organ transplant purposes: we could share information to help if you donate or receive an organ.
• For special government roles: this could be military and veteran events, national security and intelligence actions, or it could be to protect the President and others.
• About injuries on the job when required by workers compensation laws: for example, we might give your information to a program that helps you get benefits for work-related injuries.
• If one of the above does not apply, we must get your written approval to give someone information about you. This approval asks if you will let us use or share your records with others. If you change your mind, let us know. We will stop it.
• If sharing your health information is not allowed by or limited by a state law, we will obey the law that better protects your health information.

Your Rights

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The following are your rights about your health records. If you would like to use any of these rights, please contact us. Please call MHS Member Services at (877) 647-4848.

You have the right to ask us to give your records only to certain people or groups, and you have the right to say for what reasons. You also have the right to ask us to stop your records from being given to family members. You have the right to ask us to stop your records from being given to others involved in your care. While we try hard to obey your wishes, it is not the law.

You have the right to ask for a private exchange of your records. If you believe that you would be harmed if we mailed your records to your home address, you can ask us to send them another way, by fax, mailed to another address, or to your doctor.

You have the right to view and get a copy of all the records we have. This is anything we use to make decisions about your health. It includes enrollment and payment. It also includes claims and medical management records.

You do not have the right to get certain types of health records. We may decide not to give you these:
• Records that have psychotherapy notes.
• Records collected for use in a court case or other legal action.
• Records subject to federal laws about biological products and clinical laboratories.

In some cases, we may refuse to give out copies of your records. You will be informed in writing. You may have the right to have our action reviewed.

You have the right to ask us to make changes to wrong or incomplete records. These changes are known as amendments. You must ask for the change in writing. You need to give a reason for your change(s). We will get back to you in writing no later than 60 days after we get your letter.

If we need more time, we can take up to another 30 days. We will inform you of any missed dates and tell you when we will get back to you. If we make your changes, we will let you know when they were made. We will also give your changes to others we know have your records and to other persons you name.

If we choose not to make your changes, we will let you know in writing. You will have the right to send us a letter disagreeing with us. We have the right to answer your letter. You then have the right to ask that your original request for changes, our denial, and your second letter disagreeing with us be put with your records.

You have the right to receive a list of when we have given your records to others in the past six years.

By law, we do not have to give you a list of the following:
• Any records collected prior to date 4/14/2003.
• Records given or used for treatment, payment and healthcare operations purposes.
• Records given to you or others with your written approval.
• Records that are incidental to a use or disclosure otherwise permitted.
• Records given to persons involved in your care or for other notification purposes.
• Records used for national security or intelligence purposes.
• Records given to prisons, police or to FBI and others who enforce laws.
• Records given to health oversight agencies.
• Records given or used as part of a data set for research or for public health or healthcare operations purposes.

Your request for a list of disclosures has to be in writing. We will act on your request within 60 calendar days. If we need more time, we may take up to another 30 calendar days. We will give you one free list every 12 months. If you ask for another list within 12 months, we may charge you a fee. We will tell you the fee in advance and give you a change to take back your request.

Using Your Rights

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You have a right to get a copy of this notice at any time. We have the right to change the terms of this notice. Any changes in our privacy practices will apply to all the health records we keep. If we make changes, we will send you a new notice.

If you believe your rights have been broken, you may file a complaint in writing to:

Privacy Official
Managed Health Services
1099 N. Meridian Street, Suite 400
Indianapolis, Indiana 46204
(877) 647-4848.
The office is open Monday through Friday
7 a.m. to 7 p.m., EST.

Medical Privacy, Complaint Division
Office for Civil Rights
United States Department of Health and Human Services
233 N. Michigan Ave. – Suite 240
Chicago, Illinois 60601
hhs.gov/ocr
Hotline: (800) 368-1019
(312) 886-2359; TDD: (312)-353-5693

WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.