Quality Management Information for Providers
Privacy & Confidentiality
NOTICE OF PRIVACY PRACTICES
QUEST BEHAVIORAL HEALTH
EFFECTIVE DATE: APRIL 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice describes the Quest Behavioral Health practices in connection with the use and disclosure of your protected health information (PHI), your rights and certain obligations we have regarding the use and disclosure of your PHI. This Notice and the privacy practices described in it apply to your PHI regardless of where the information is maintained or collected by Quest Behavioral Health.
We are required by law to maintain the privacy of your PHI and to provide you with this Notice describing our privacy practices. We are required to abide by the terms of this Notice, as it is modified from time to time. We understand that PHI about you and your health is personal. We also take the required security steps for the internal protection of oral, written, and electronic PHI across Quest Behavioral Health.
If you have any questions about this Notice, please contact the Privacy Officer, Quest Clinical Director, at PO Box 1032, York, PA 17405-1032.
(717) 851-1486 or (800) 364-6352.
WE MAY MAKE CHANGES TO THIS NOTICE IN THE FUTURE, AND ANY OF THE TERMS OF THIS NOTICE THAT ARE CHANGED WILL APPLY TO ALL OF YOUR PROTECTED HEALTH INFORMATION. IF WE CHANGE OUR NOTICE, YOU MAY OBTAIN A COPY OF THE REVISED NOTICE BY REQUESTING IT BY PHONE OR BY SENDING A WRITTEN REQUEST FOR A COPY TO THE PRIVACY OFFICER AT THE ADDRESS LISTED ABOVE. YOU MAY ALSO REVIEW OUR NOTICE ON-LINE AT WWW.QUESTBEHAVIORALHEALTH.COM.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We are permitted or required to use your PHI for various purposes. We cannot describe every possible use or disclosure of your PHI in this Notice. However, uses or disclosures that we are permitted or required to make will generally fall within one of the following categories. Use and disclosure of PHI for other than the following categories would require your written authorization. Other than as permitted below, disclosure of PHI to plan sponsors or employers would require your written authorization.
For Treatment - We may use and disclose PHI about you in order to ensure that you receive proper treatment. We may disclose PHI about you to doctors, therapists, nurses, technicians, medical students, or other personnel who are involved in taking care of you. For example, if you are treated in the emergency room, information regarding your visit may be disclosed to your treatment provider so that he or she can be kept up to date regarding your health. If you are referred to a specialist, information regarding your healthcare may be shared with the specialist in order to assist him or her in evaluating your healthcare needs. If you are in a facility, different departments of that facility may share PHI about you in order to coordinate the different aspects of your care, such as prescription of medications, lab work and tests. We may also disclose your PHI to another health care provider who is involved in your care. We may use and disclose PHI to coordinate behavioral health services with your primary care provider or other medical care.
For Payment - We may use and disclose PHI about you so that the treatment and services provided to you may be billed to and payment may be collected from you, an insurance company or Quest Behavioral Health, to determine eligibility for benefits, or to coordinate coverage. For example, we may need to give your health care provider information about your medical history to determine whether a particular treatment is experimental, investigational or medically necessary or to determine whether Quest Behavioral Health will cover the treatment. We may also share PHI with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments. We may also disclose your PHI to another entity that is covered by the privacy regulations or a health care provider for that entity's payment.
For Health Care Operations - We may use and disclose PHI about you for other plan operations. Plan operations are activities that are necessary to run Quest Behavioral Health such as conducting quality assessment and improvement activities; underwriting, premium rating, disease management, plan design and other activities relating to coverage; submitting claims for stop-loss (or excess loss) coverage; conducting or arranging for medical review, legal services, audit services and fraud and abuse detection programs; business planning and development such as cost management; and business management and general administrative activities.
For Case Management & Prevention - We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services provided by Quest Behavioral Health that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care - Unless otherwise restricted by federal and state laws, we may release PHI about you to a family member, domestic partner, common law partner, personal representative, or close personal friend who is involved in your medical care or payment for that care. The PHI will be relevant to that person's involvement in your care or payment related to your care.
As Required by Law - We will disclose PHI about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety - We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threatened harm.
Other Special Situations
- Organ and Tissue Donation - PHI may be disclosed to organ procurement organizations;
- Military and Veterans - PHI may be disclosed to military command authorities;
- Worker's Compensation - PHI may be disclosed on work-related injuries;
- Public Health Risks - PHI may be disclosed to public agencies to prevent or control disease, report births and deaths, abuse or neglect and product problem/recall issues.
- Health Oversight Activities - PHI may be disclosed to a health oversight agency for activities authorized by law including to organizations designated by the Medicare program to review medical services provided to Medicare beneficiaries.
- Lawsuits and Disputes - PHI may be disclosed in response to a court or administrative order, subpoena, discovery request or other lawful process.
- Law Enforcement - PHI may be disclosed to law enforcement officials (1) in response to a court order, subpoena, warrant, summons or similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct at a Quest Behavioral Health facility; and (6) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors - PHI may be disclosed to identify a deceased person, determine cause of death, or for burial purposes.
- Government Purposes - PHI may be disclosed to (1) authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, (2) authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations. If you are an inmate of a correctional institution or under the custody of a law enforcement official, PHI may be disclosed to (1) allow the institution to provide you with health care, (2) protect your health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.
- Incidental Uses and Disclosures - PHI may be disclosed if it is a by-product of any of the uses or disclosures described above and it could not be reasonably prevented.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights regarding the protected health information (PHI) we maintain about you:
Right to Inspect and Copy - You have the right to inspect and copy your PHI that is in our possession. You may not, however, have access to psychotherapy notes or information that is gathered for use in a civil, criminal or administrative proceeding. We may deny your request to inspect or copy your PHI in certain very limited circumstances. Your request may be denied to the extent that the information is protected by the Privacy Act or was provided to your healthcare providers by someone else under a promise of confidentiality.
Right to Amend - If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend that information. Your request must be in writing and sent to the Quest Behavioral Health Privacy Officer at the address listed above and must explain why you believe that the PHI is incorrect or incomplete. We may deny your request for amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment, (2) is not part of the PHI kept by us (3) is not part of the information which you would be permitted to inspect and copy or (4) is accurate and complete.
Right to Accounting of Disclosures - You have the right to request a listing of our disclosures of your PHI. However, we are not required to include on that list any of the following: (1) disclosures to carry out your treatment, payment for your care and our health care operations, (2) disclosures to you, (3) disclosures for national security or law enforcement purposes, (4) if you are an inmate, disclosures to correctional institutions or law enforcement officials, (5) disclosures that occurred prior to April 14, 2003 or (6) disclosures that were made pursuant to your authorization.
To request this accounting of disclosures, you must submit your request in writing to the Quest Behavioral Health Privacy Officer listed above. Your request must state a time period covered by your request, which can be no longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the costs involved and you may choose to withdraw or modify your request before any costs are incurred.
Right to Request Restrictions - You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. However, we are not required to agree to your request. If we do agree, we will comply with the request unless the information is needed to provide you emergency treatment, and we may terminate the restriction at any time by notifying you of that termination.
To request restrictions, you must make your request in writing to the Quest Behavioral Health Privacy Officer at the address listed above. Your request must list what information you want to limit, whether you want to limit our use, disclosure or both and to whom you want the limits to apply (for example - disclosures to your spouse).
Right to Request Confidential Communications - You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to the Quest Behavioral Health Privacy Officer at the address listed above. We will attempt to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice - You may obtain a copy of this Notice at www.questbehavioralhealth.com. You may also request a paper copy of this Notice in person or by sending a written request for a copy to the Quest Behavioral Health Privacy Officer at the address listed above.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact the Privacy Officer, Quest Clinical Director at
(717) 851-1486 or (800) 364-6352 or at the address listed above.
If you believe your privacy rights have been violated, you can file a complaint with the Quest Behavioral Health Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Effective Date of Notice - April 14, 2003
