Notice of Privacy Practices
IMPORTANT: This notice outlines how your medical information may be used and shared, and explains your rights regarding that information. Please read it carefully.
Overview
This Notice of Privacy Practices (the “Notice”) explains how 1st Optimal. and its Affiliated Covered Entity members (collectively referred to as “we” or “our”) may use and disclose your protected health information (PHI) to provide treatment, obtain payment, and manage business operations, as well as for other legally permitted purposes. An Affiliated Covered Entity is a group of health care providers that operates under common ownership or control, designed to comply with the Health Insurance Portability and Accountability Act (HIPAA). In some instances, we may be classified as a Covered Entity under HIPAA and are required to adhere to its regulations. When HIPAA applies, we have formed an Affiliated Covered Entity, allowing members to share PHI for treatment, payment, and health care operations as permitted by HIPAA and this Notice. For a full list of our Affiliated Covered Entity members, please contact the 1st Optimal Privacy Officer.
“Protected health information” (PHI) refers to information about you, including demographic details, that can identify you and relates to your health history, treatment, or payment for health care services. This Notice also details your rights regarding access to and control over your PHI.
Uses and Disclosures of Protected Health Information
Your PHI may be used and disclosed by our health care providers, staff, and authorized individuals involved in your care. This may include:
Treatment
We will use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example, we may share your information with a referred health care provider to ensure they have the necessary details for your diagnosis or treatment.
Payment
Your PHI may be used to bill for your health care services. This includes activities that your health insurance plan might undertake to determine eligibility or coverage, and to review services provided for medical necessity.
Health Care Operations
We may use or disclose your PHI as needed to support our business activities. This includes improving care quality, providing information about treatment options, managing our computer systems, legal services, and conducting audits or compliance programs.
Situations Not Requiring Your Authorization
We may use or disclose your PHI without your authorization in specific situations, such as:
- As required by law
- For public health activities
- For health care oversight
- In cases of abuse or neglect reporting
- In connection with legal proceedings
- For law enforcement purposes
- To coroners, funeral directors, and organ donation agencies
- For certain research activities
- Related to military and national security
- For workers’ compensation reporting
We are also required by law to provide certain disclosures upon your request, and as mandated by the Secretary of the Department of Health and Human Services for HIPAA compliance investigations.
Situations Requiring Your Authorization
Other uses and disclosures of your PHI will only occur with your consent or authorization, unless otherwise permitted by law. Specifically, we cannot use or disclose your PHI for marketing purposes or sell your PHI without your consent. You can revoke any authorization in writing, except for actions already taken based on that authorization.
Your Rights Regarding Your Protected Health Information
You have several rights concerning your PHI:
- Right to Inspect and Copy: You may access and obtain copies of your PHI.
- Right to Amend: You can request changes to your PHI.
- Right to Request Restrictions: You may request limitations on the use or disclosure of your PHI, but we are not obligated to agree to your request, except under specific circumstances.
- Right to Confidential Communications: You can request to receive communications regarding your PHI by alternative means or at a different location.
- Right to an Accounting: You can request a list of certain disclosures of your PHI.
- Right to a Paper Copy: You can obtain a paper copy of this Notice upon request, even if you’ve received it electronically.
Revisions to This Notice
We reserve the right to update this Notice and make it effective for all PHI we maintain, both past and future. You are entitled to receive a copy of the current Notice. Any significant changes will be posted on our website.
Breach of Health Information
If we discover a reportable breach of your unsecured PHI, we will notify you within 60 days. This notification will include a description of the breach, the information involved, and contact details for inquiries.
Complaints
If you have concerns about this Notice or how we manage your PHI, please contact our HIPAA Privacy Officer. If you’re unsatisfied with our response, you may file a complaint with the Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
We are committed to maintaining the privacy of your PHI and adhering to the practices outlined in this Notice. If you have any questions, please contact us at +1 (816) 744-6814 or email membersupport@1stoptimal.com and ask to speak with our HIPAA Privacy Officer. All PHI can only be sent after signed authorization via fax to +1 (248) 206-3800.