Notice of Privacy Practices for Protected Health Information
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.
We understand that health information about you and your health is personal.
We, therefore, are committed, and required by law, to maintain the privacy of your health information and to provide you with notice of your rights, as well as our legal duties and privacy practices with respect to your health information. Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient’s health care history and other personal information. We will not use or disclose your health information except as described in this Notice. This Notice applies to all the health information maintained by Breakthrough Healthcare and its affiliates.
Breakthrough Healthcare and its affiliates may share your health care information with each other to carry out treatment, payment, and health care operations.
How We May Use and Disclose Your Health Information:
We may use and disclose your health information as described below. However, this Notice is only meant to give you a general overview and not to describe all specific possible uses and disclosures that may occur.
We may use your health information to provide treatment. For example, we may disclose all or any portion of your health information to your physicians, nurses, and other health care professionals who have a need for such information for your care and treatment.
Different departments may also share health information about you in order to coordinate specific services. We may also disclose your health information to people Breakthrough Healthcare who may be involved in your medical care, such as family members, a social service worker, clergy and/or others that provide services that are part of your care. Additionally, our staff may discuss your care in a case conference.
We may use and disclose health information about you so that we may bill and receive payment for treatment and services that you receive. Your information may also be necessary for purposes of determining coverage, medical necessity, pre-authorization or certification, and utilization management. The information may be disclosed to an insurance company, third party payer or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or portions of your medical record, which are necessary for payment of your account. For example, a bill sent to an insurance company may include information that identifies you, your diagnosis, and the procedures and supplies used. Your health information may also be disclosed to consumer reporting and/or collection agencies.
For Health Care Operations
We may use and disclose your health information for our health care operations, including quality assurance, medical review, auditing, accreditation, licensing or credentialing activities, and educational purposes. For example, we may review your health information to make sure that Breakthrough Healthcare is providing quality care to all its patients.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services
We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical/dental care at Breakthrough Healthcare. We may use and disclose your health information to tell you about possible treatment options or alternatives, or other health-related benefits that may be of interest to you.
For Other Health Care Providers, Health Plans, and Clearinghouses
We may use and disclose your health information to your treating provider or health plan, or a clearinghouse involved in the billing of services and treatment provided to you, for the purpose of providing you treatment, receiving or processing payment, and to conduct certain operational activities as permitted by law.
For Activities of Organized Health Care Arrangements in Which We Participate
For certain activities, the various components of Breakthrough Healthcare (listed earlier in this Notice) and other independent entities are called an Organized Health Care Arrangement. We may disclose information about you to entities participating in our Organized Health Care Arrangements as necessary to carry out our treatment, payment and health care operations. All participants in our Organized Health Care Arrangements have agreed to abide by the terms of this Notice with respect to your health care information created or received as part of the delivery of health care services to you at Breakthrough Healthcare.
While most uses and disclosures related to research require your authorization, in some limited situations we may use and disclose your health information for research when an Institutional Review Board or a similar privacy board has approved a waiver of the individual authorization requirement in accordance with the regulations covering this area.
USES/DISCLOSURES WITHOUT AN AUTHORIZATION
Required by Law
We may use and disclose health information about you when required to do so by federal or state law.
We may use and disclose health information to business associates. A business associate is an individual or entity under contract to us to perform or assist in a function or activity which requires the use or disclosure of health information. We require the business associate to enter into an agreement to protect the confidentiality of your health information.
Organ Procurement Organizations
We may use and disclose your health information to organ procurement organizations and other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.
Health Oversight Agencies
We may use and disclose your health information to a health oversight agency for activities authorized by law, including licensure, audits, investigations and inspections. These activities are necessary for the government and certain private health oversight agencies to monitor the health care system, government programs and compliance with civil rights.
We may disclose your health information to a law enforcement official if required by law, or where permitted by law, or in response to a valid subpoena. We also may disclose health information if it is necessary for law enforcement authorities to identify or locate an individual.
Disclosures in Judicial/Legal Proceedings
We may disclose your health information to a court or administrative agency when a judge or administrative agency orders us to do so. We may also disclose information about you in legal proceedings, such as in a response to a discovery request, subpoena or court order. Breakthrough Healthcare may also use and disclose your health information in preparation for any dispute or litigation between you and Breakthrough Healthcare.
Public Health Risk
We may use and disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may have to make other uses and disclosures including:
- To report births and deaths.
- To report child abuse and neglect.
- To report reactions to medications or problems with products.
- To notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition.
- To notify the appropriate government authority if Breakthrough Healthcare believes a patient has been the victim of abuse, neglect or domestic violence.
Safety of a Person or the Public
We may use and disclose your health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
We may use and disclose health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities.
Inmates or Individuals in Custody
If you are an inmate of a correctional institution or under the custody of a law enforcement officer, we may disclose your medical record information to the correctional institution or law enforcement official. This disclosure may occur:
- for the institution to provide you with health care;
- to protect your health and safety and that of others; or
- for the safety, security, and good order of the correctional institution.
National Security and Intelligence Activities
We may use and disclose your medical information to authorized federal officials for intelligence, counterintelligence, and other National Security activities as authorized by law. We may also disclose health information about you to authorized federal officials so they may provide protection to the President or other authorized persons.
Coroners, Medical Examiners, Funeral Directors
We may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine a cause of death. We may also disclose your health information to funeral directors as necessary to carry out their duties.
Secretary of the Department of Health and Human Services
We may use and disclose your health information when required by the Secretary of the Department of Health and Human Services for purposes of investigating or determining compliance with federal privacy regulations.
USES/DISCLOSURES THAT REQUIRE THE OPPORTUNITY TO OBJECT
Persons Involved in Your Care or Payment of Your Care Unless you object, we may disclose your health information to family members, other relatives, close personal friends, or any other person(s) you identify who are involved with your medical care or payment.
Unless you object, we may use and disclose your health information to a public or private entity authorized by law or by charter to assist in disaster relief efforts, including notifying your family about your condition, status and location.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your PHI will be made only with your written authorization: 1) Disclosures that constitute a sale of your Protected Health Information; and 2) Uses and Disclosures of Protected Health Information for marketing purposes.
Any other uses and disclosures of your health information will be made only with your written authorization.
Your Rights Regarding Your Health Records
Although your health records are Breakthrough Healthcare’s property, you have the following rights:
Right to Confidential Communications
You have the right to request to receive confidential communications of your health information by alternative means or at alternative locations. To exercise your right, please write to the address at the end of this section.
Right to Request to Inspect and to Obtain a Copy
You have the right to inspect and obtain a copy of your health information. However, such requests may be denied as permitted under the law. You may have the right to appeal such denials. To exercise your right, please write to the address at the end of this section. (Copying fees may be imposed.)
If you paid out-of-pocket (or, in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your health information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Right to Request Amendment
You have the right to request to amend your health information. However, Breakthrough Healthcare may deny your request to amend your health information under certain circumstances. All requests for amendments must be in writing and provide a reason supporting your request for an amendment. To exercise your right, please write to the address at the end of this section.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your health information. However, Breakthrough Healthcare is not required to agree to such requests. You must communicate your specific request in writing by using the proper form. To exercise your right, please write to the address at the end of this section.
Right to an Accounting of Disclosures
You have the right to request that we provide you with an accounting of disclosures we have made of your health information. An accounting is a list of disclosures. This list will not include certain disclosures of your health information, including disclosures made for treatment, payment, or health care operations, made to you, or made pursuant to an authorization signed by you.
The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six (6) years and should not include dates before January 1, 2020. The first accounting you request within a twelve (12) month period will be free. For additional requests during the same twelve (12) month period, we will charge you for costs of the accounting. We will notify you of the amount we will charge and you may choose to withdraw or change your request before you are charged any costs. To exercise your right, please write to the address at the end of this section.
Right to Receive a Copy of this Notice
You have the right to receive a paper copy of this Notice upon request. You may also obtain a copy of this Notice at our website: BreakthroughHealthcareStLouis.com
Right to Revoke Your Prior Authorization
You have the right to revoke your authorization (your permission) to use or disclose your health information except to the extent that action has already been taken in reliance on your prior authorization. To exercise your right, please write to the address at the end of this section.
Right to Receive Notification of a Breach
Breakthrough Healthcare is required to notify you following the discovery of a breach of your unsecured health information.
All requests to exercise your rights above must be made in writing to the address below:
Attn: Nikki Lindsay,
For More Information or to Make a Complaint
If you have questions or would like additional information, you may call Nikki Lindsay at 314-649-5586. If you believe your privacy rights have been violated, you may file a complaint with Breakthrough Healthcare or with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a complaint.
Changes to This Notice
Breakthrough Healthcare will abide by the terms of the Notice currently in effect. However, Breakthrough Healthcare reserves the right to change the terms of its Notice and to make the new Notice provision(s) effective for all health information that it maintains. Breakthrough Healthcare will promptly post the revised Notice on our website: BreakthroughHealthcareStLouis.com.
Reliance on this Notice by Other Health Care Entities
Breakthrough Healthcare participates in an Organized Health Care Arrangement with providers and entities that may not be employed by Breakthrough Healthcare, but participate in your health care. Any providers or entities participating in this arrangement may rely on this Notice as providing you with notice of their privacy practices.
The effective date of the Notice is January 1, 2020.
Adherence to Guidelines
If you believe that Breakthrough Healthcare has not adhered to the above policies, please notify us at 314-649-5586 and we will work to determine the veracity of the issue and, if appropriate, correct it accordingly. Please do not hesitate to contact us at any time. Thank you.