Your Right to Privacy

Your Right To Privacy

Privacy Practices

THIS NOTICE EXPLAINS HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

As your health plan, CalOptima sees information about your health. We want you to know that we protect it. These are some of the things we do to protect it:

We limit the number of people to whom we show your health information.
We ask those people to protect it.
We let you check the information we have about you to make sure it is correct.

How does CalOptima use this information?

Treatment: To help doctors and other health care providers treat you. For example, we share it with hospitals, doctors and other health care providers to help them coordinate your health care services.
Payment: To pay for health services that you receive. For example, we share it with providers so that they know you are covered by CalOptima and that your health care services will be paid for by CalOptima.
Health care operations: To operate CalOptima. For example, we use this information to make sure that you receive the health care services you need.

We may also share your health information with public agencies or other organizations in certain instances in which we are required or permitted by law. These include the following types of instances:

To respond to requests from government agencies
To agencies that handle organ donations
To meet legal requirements. Examples include reporting to public health, law enforcement and, if necessary, to avoid a serious threat to public health or safety.
To research projects that meet review board standards
To coroners and medical examiners
To measure and retain information about your preventive health visits (for example: annual checkups and vaccinations)

Where do we get this information?

From you
From hospitals, doctors and others providing covered health services
From other companies and public and community agencies with which we
do business

Who do we show it to?

Our employees
Our doctors and other health care givers
Other companies and public and community agencies with which we
do business
People who have a legal right to see it
Agencies that regulate our business

How do we protect the information we have about you?

Our employees and health care givers sign an agreement to keep it private.
Other companies and agencies we do business with agree to keep it private.
The law requires that legal and regulatory agencies keep it private.
We follow any limitations to using or sharing your information required by law including information related to mental health, alcohol and drug abuse or HIV/AIDS status.

Do we ever use it for any other reason?

No, not unless you tell us we can. If we want to use it for a special reason, we need to ask for your consent in writing. If you do not give us written consent, we can't
use it.

Can you ever ask us to use it for a special reason?

Yes. If you ask us to send your medical records to someone, we will. If you ask us to stop, we will stop.

Your New Rights

You have more control over the health information we have about you. You can:

Ask us to limit the information we share and who we share it with. (But we will not have to do what you ask)
Write to us to get a copy of information we have about you. If it looks wrong to you, you can ask us, in writing, to change it. If someone else gave us the information, we will tell you who, so you can ask them to change it.
Ask that we contact you at a different address if it is dangerous for you to get health information at home.
Get a copy of information we have shown people on or after April 14, 2003. The only exceptions are information used for treatment, payment or health care operations; this information is protected by law.
Get a list of parties who received your information unless it was given related to treatment, payment for services, operations of our plan, authorized by or made directly to you. The request must be for the time period on or after April 14, 2003.

Complaints

If you think we have not protected your privacy, you can file a complaint with us or with the federal government. We will not hold this against you. You can reach us by calling our Customer Service Department at 1-800-530-2899.

Copies

You have the right to receive a copy of this notice. You can receive another copy of it at any time.

Changes

We can make changes to this policy on your right to privacy. We will let you know about the changes through the For Your Health newsletter we send you, a notice mailed to your address or posted on this Website.

How can you reach us?

Please call our Customer Service Department at 1-800-530-2899 if you want to:

Ask us to do something we talk about in this policy notice.
Talk to us about keeping information private.
File a complaint with us.

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