Quality Management Information for Members
Privacy & Confidentiality
In order to do our job, we receive and use information about members. This information could be in the form of medical records, claims and other administrative data that are personally identified. This information is known as protected health information or PHI. Privacy and confidentiality are very important to us. We follow strict policies and procedures to protect your privacy and confidentiality in all settings. We have policies and procedures that address
- Who has access to your PHI.
- How you can request restrictions on the use or disclosure of your PHI.
- How you can request amendments to your PHI.
- How you can request an accounting of disclosures of your PHI.
How we internally protect your PHI in our organization whether the PHI information is in oral, written or electronic form. We have security provisions in place to protect your PHI.
We send out privacy notices to our members. The privacy notice gives a more detailed description of our use or disclosure of PHI and your health information rights; and we give our providers copies of these policies and procedures along with some others that describe ways to protect privacy and confidentiality in their own offices. Quest's Quality Management Committee oversees confidentiality and issues of privacy. The QM Committee looks at ways to reduce the amount of PHI information that is collected.
We are permitted to use or disclose your PHI under the following circumstances:
- To ensure you receive proper treatment.
- To ensure services provided to you are billed to and payment may be collected, to determine eligibility of benefits or to coordinate coverage.
- For other health plan operations including quality assessment and improvement activities.
- For case management and preventive services.
- As required by law.
- To avert a serious threat to health or safety.
- Under other special circumstances.
You have the following rights regarding your PHI in our possession:
- Right to inspect and copy.
- Right to amend.
- Right to request a list of our disclosures of your PHI that is not required or permitted.
- Right to request restrictions or limitation on the PHI we disclose.
- Right to request confidential communication of your PHI; that is, you may request we disclose PHI in a certain way or certain location.
- Right to request a paper copy of our privacy practices.
If we use information for other reasons, we will change or remove any portions that could allow someone to identify you or we will contact you to ask for written authorization to use the information. You can deny or limit permission to release information. Examples of when we would contact you include requests for information to process a worker's compensation or automobile insurance claim; sharing behavioral health treatment information with your primary care physician; and research.
The authorization for release of protected health information includes:
- The name of the person or entity providing the information.
- The type of treatment or the level of care the release is effective for.
- The specific information to be released.
- The purpose for the release.
- The individual or entity authorized to receive the information.
- The expiration date of the authorization.
- Signature of member or member's legally authorized representative.
- Member's date of birth and social security number.
- Signature of witness.
- Date of the authorization.
Minors under the age of 14 and members who are under legal guardianship are not able to give written authorization to release information. In these circumstances, we ask the member's legally authorized representative to give written authorization to release information. We only provide information to persons who are legally authorized to receive information.
Employers may request information from Quest. Often we can provide data and information without identifying the member. We require employers to agree in writing to protect all information that identifies members from being used in any decisions that affect the member. We require special protections be in place before we provide any protected health information. Quest provides only the minimum amount of information needed. We never share any protected health information outside of that mentioned without your written authorization.
Quest does not provide direct care or treatment. We do not maintain medical or treatment records. Your physician, therapist, hospital or other treatment facility keeps your records. You can obtain information about treatment from them.
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.
