Privacy Policy
Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities.
Effective Date: August 26, 2024
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.
If you have any questions about this notice, please contact our Privacy Officer, Bridget Stockdill, at compliance@marpaihealth.com.
OUR OBLIGATIONS:
We are required by law to:
- Maintain the privacy of Health Information protected under the federal HIPAA Privacy Rule (“HIPAA”)
- Give you this notice of our legal duties and privacy practices regarding Health Information about you
- Follow the terms of our notice that is currently in effect
- Notify you following a breach of your Health Information that is not secured in accordance with certain security standards
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION:
The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission (referred to as your “Authorization.”). You may revoke such Authorization at any time by writing to our Privacy Officer. Please note that revocation of your Authorization will not affect actions we took in reliance on your written Authorization prior to the time that you revoked such Authorization.
For Treatment. We may use and disclose Health Information to aid in your treatment. For example, we may share your Health Information with your doctors to help them provide medical care to you.
For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our members receive quality care and to manage our operations. For example, we may use and disclose information to make sure the surgical care you receive is covered or non-covered. We also may share information with other entities that have a relationship with you (for example, your health care provider) for their health care operation activities.
For Payment. We may use and disclose Health Information so that we or others may bill and receive payment from you, for the treatment and services you received. For example, we may give a repricing plan information about you so that they will negotiate treatment cost with you.
For Health Plan Administration Purposes. We may disclose Health Information to the Health Plan Sponsor as necessary to administer the Health Plan and as permitted by HIPAA.
For Underwriting Purposes. We may use or disclose your Health Information for underwriting purposes, and we are prohibited from using or disclosing your genetic information for these purposes.
SPECIAL SITUATIONS:
As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with product; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a member has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Research. Under certain circumstances, we may use and disclose Health Information for research. For example, a research project may involve comparing the health of members who received one treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at reports to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your Health Information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is:
(1) in response to a court order, subpoena, warrant, summons or similar process;
(2) limited information to identify or locate a suspect, fugitive, material witness, or missing person;
(3) about the victim of a crime even if, under certain very 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 on our premises; and
(6) in an emergency 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 and Medical Examiners. We may release Health Information to a coroner or medical examiner.
National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be if necessary:
(1) for the institution to provide you with health care;
(2) to protect your health and safety or the health and safety of others; or
(3) the safety and security of the correctional institution.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
Notification Purposes; Disaster Relief. We may disclose your Health Information to disaster relief organizations that seek your Health Information to coordinate your care or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.
OTHER USES AND DISCLOSURES REQUIRE WRITTEN AUTHORIZATION OR AN ATTESTATION
The following uses and disclosures of your Health Information will be made only with your written authorization:
- Most uses and disclosures of Health Information for marketing purposes,
- Disclosures that constitute a sale of your Health Information; and
- Most uses and disclosures of psychotherapy notes (private notes of a mental health professional kept separately from a medical record).
Other uses and disclosures of Health Information not covered by this Notice or the laws that apply to us will be made only with your written Authorization. If you do give us an Authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Health Information under the Authorization. Any disclosure we made in reliance on your Authorization before you revoked it will not be affected by the revocation.
ADDITIONAL RESTRICTIONS ON USES AND DISCLOSURES OF CERTAIN HEALTH INFORMATION
HIPAA Protections for Reproductive Health Care Information. HIPAA imposes additional restrictions regarding the use and disclosure of certain Health Information related to reproductive health care. Specifically, we may not use or disclose your Health Information in response to a request associated with a criminal, civil, or administrative investigation related to, or to impose liability for seeking, obtaining, providing, or facilitating, lawful reproductive health care. If we receive a request for your Health Information and the request includes Health Information potentially related to reproductive health care, we will require the requester to sign an attestation that states that the requested Health Information will not be used for such prohibited purpose.
Other More Restrictive Federal and State Laws. Some federal and state laws and regulations may require special privacy protections that restrict the use and disclosure of certain types of Health Information. We will follow the more stringent and protective law, where it applies to us, including as follows:
Records Under 42 CFR Part 2. If we receive records subject to the federal regulations, 42 CFR Part 2, which pertains to substance use disorder patient records, we adhere to the following requirements:
The uses and disclosures of Health Information that we make without your authorization for treatment, payment, health care operations and the other purposes described above in this Notice may be subject to additional restrictions when the Health Information at issue consists of substance use disorder treatment records received from programs subject to 42 CFR part 2 (“Substance Use Disorder Records”).
In addition, Substance Use Disorder Records or testimony relaying the content of such records, will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual who is the subject of the records unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record, as provided in 42 CFR part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.
Other State Laws. Some states have laws that are stricter than the federal privacy regulations, such as laws protecting HIV/AIDS information or mental health information. If a state law applies to us and is stricter or places limits on the ways we can use or share your Health Information, we will follow the state law.
REDISCLOSURE OF HEALTH INFORMATION BY RECIPIENTS
Once your Health Information is disclosed as described in this Notice, your Health Information may no longer be protected by HIPAA and may be subject to further disclosures to other third parties by the recipients of your Health Information.
YOUR RIGHTS:
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to claims@marpaihealth.com.
We have up to 30 days to make your Health Information available to you and we may charge you a reasonable cost-based fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed health care professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Health Information in the form or format you request, if it is readily producible in such form or format. If the Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. When applicable we may charge you a reasonable, cost-based fee.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Health Information.
Right to Amend. If you feel that your Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to claims@marpaihealth.com.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request in writing to compliance@marpaihealth.com.
Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend or for certain notification purposes. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request in writing to compliance@marpaihealth.com.
As a health plan, we are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes, the disclosure is not otherwise required by law, and such information you wish to restrict pertains solely to a health care item or service for which you or a person other than the health plan have paid “out-of-pocket” in full. If we have agreed to your requested restriction, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to Request Confidential Communications. You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request in writing to csmanagers@marpaihealth.com. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our web site www.marpaihealth.com. To obtain a paper copy of this Notice, email csmanagers@marpaihealth.com.
CHANGES TO THIS NOTICE:
We reserve the right to change this Notice and make the new Notice apply to Health Information we already have, as well as any information we receive in the future. We will post a copy of our current Notice on our website www.marpaihealth.com. The Notice will contain the effective date on the first page, in the top right-hand corner.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact compliance@marpaihealth.com. All complaints must be made in writing. You will not be penalized for filing a complaint.
Attention: Bridget Stockdill, Privacy Officer
Contact Email Address: compliance@marpaihealth.com
