PRIVACY NOTICE TO OUR CLIENTS
Effective March 31, 2003

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.
THIS NOTICE IS FOR YOUR INFORMATION. NO RESPONSE IS REQUIRED.

American Healthcare Alliance strongly believes in protecting the confidentiality and security of information we collect about you. This notice describes our privacy policy and describes how we may use and disclose health information about you. It also describes your rights, and certain obligations we have, regarding your Protected Health Information (“PHI”).

Why and How We Collect PHI: We collect information in the normal course of business with respect to our business relationships in order to administer your accounts and to serve you better. We get most information directly from health care providers and entities you access. If we need to verify information, or need additional information, we may obtain that information from third parties whom you authorize to provide us with information, employers, other insurers, physicians, hospitals and other medical personnel.

How We Protect PHI: We treat information in a confidential manner and our employees are required to protect the confidentiality of such information. Employees may access information only when there is an appropriate reason to do so, such as to administer our services. We also maintain physical, electronic and procedural safeguards to protect information; these safeguards comply with all applicable laws. Employees and business partners are required to comply with our established policies relating to confidentiality and privacy of non-public information about you. With respect to situations in which disclosure is not required or permitted by law, we will not disclose non-public personal health information about you unless an authorization is obtained from you or your authorized representative.

Uses and Disclosures for Treatment, Payment, and Healthcare Operations: We use and disclose information in a number of different ways in connection with the payment for your health care, and our health care operations, including disclosures of such information to participants of any organized health care arrangement in which we participate. The following are a few examples of the types of uses and disclosures of your information that we are permitted to make without your authorization.

Treatment: We may disclose information to health care providers who request it in connection with a claim.

Payment: We may use and disclose information, which may involve claims repricing, and other services.

Health Care Operations: We may use and disclose information to support our general administrative activities.

Other Permitted or Required Uses and Disclosures of PHI: We may use or disclose your PHI in the following additional situations without your authorization:

  • Others Involved in Your Healthcare: American Healthcare Alliance has policies and procedures that provide for the release of information about payment for a claim to a member of your family, a relative, a close friend, or any other person when you are not present or able to give authorization for the release of information. For example, if a family member or a caregiver calls our customer service line with basic information about you (ID number, address, date of birth, etc.) and with prior knowledge of a claim (date of service, name of provider, type of procedure, etc.), we will confirm whether or not the claim has been received unless you have previously informed us in writing that you do not want us to make any such disclosures under such circumstances. If you are present for such a disclosure (whether in person or on a telephone call), we will either seek your verbal agreement to the disclosure or provide you an opportunity to object to it.
  • Required by Law: We may use or disclose your PHI to the extent we are required to do so by federal, state, or local law.
  • Judicial Proceedings: In connection with lawsuits or other legal proceedings, we may disclose PHI in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request, or other lawful process.
  • Law Enforcement: We are permitted to disclose PHI under limited circumstances to a law enforcement official. For example, disclosures may be made for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; or to provide information concerning victims of crime.
  • Military Activity and National Security: We are permitted to disclose your PHI to Armed Forces personnel under certain circumstances and to authorized federal officials for the conduct of national security and intelligence activities. However, in the course of our normal business operations, these are not types of disclosures that American Healthcare Alliance would make.
  • Workers Compensation: We are permitted to use or disclose PHI about you as authorized by laws relating to workers’ compensation or other similar programs. However, in the course of our normal business operations, this is not a type of use or disclosure that American Healthcare Alliance would make.

Upon receipt of appropriate certifications from your employer or other organizations that help pay for your participation in the plan, American Healthcare Alliance may share information with such persons to permit them to perform plan administration functions. However, if your employer or another organization that pays for your participation asks for specific PHI about you for a purpose other than plan administration or your participation in the plan, we will get your authorization before we disclose your PHI to them.

Information may be shared with third party “business associates” that perform various activities for us or on our behalf. Whenever such an arrangement involves the use or disclosure of PHI, we will have a written contract with such third party that contains terms designed to protect the privacy of your PHI.

Uses and Disclosure of PHI with an Authorization: Any other use or disclosure that is not otherwise permitted or required by law will be made only with your written authorization.

We Do Not Sell Personal Protected Health Information to Anyone: We do not make any other disclosures of information to other companies which are not Affiliates and who may want to sell their products or services to you. For example, we will not sell your name to a catalog company. Companies we hire to provide support services are not allowed to use your personal information for their own purposes and are contractually obligated to maintain strict confidentiality. We limit their use of your personal information to the performance of the specific service we have requested.

Accounting of Certain Disclosures: You have the right to request us to provide you with an accounting of times when we have disclosed your PHI. An accounting of disclosures will not include those that were made:

  • For treatment, payment, or health care operations
  • To you or to your personal representative
  • Incidentally to a permitted use or disclosure
  • Pursuant to an authorization received from you or your personal representative
  • For our facility directory or to persons involved in your care or for other notification purposes
  • For National Security purposes
  • To corrections or law enforcement personnel
  • As part of a limited data set
  • Before April 14, 2003.

The accounting will include disclosures made within the last six years, unless you request a shorter time period or if less than six years have passed since April 14, 2003. Your request for an accounting of disclosures must be made in writing on the form provided by American Healthcare Alliance and must provide us with the specific information we need to fulfill your request. We will respond to your request within 60 days. If you request this accounting more than once in a 12-month period, we may charge you a reasonable fee.

To obtain the forms necessary to exercise your rights, contact Participants Services at American Healthcare Alliance, 316-609-2390 or 800-660-8114. All completed request forms should be sent to American Healthcare Alliance, Attn: HIPAA Compliance Coordinator, 9229 Ward Parkway, Suite 300, Kansas City, Missouri 64114.

Further Information: A recently enacted federal law establishes new privacy standards and requires us to provide this summary of our privacy policy once each year. We are required to abide by the terms of this notice. We may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain, including PHI that was created or received prior to the date of such change. We will redistribute a new Notice of Privacy Practices whenever we make a material change in our privacy practices described in our notice. You may have additional rights under other applicable laws.

Questions and Complaints: For additional information or if you have any questions regarding our privacy policy, please contact us by e-mail at claims@ahappo.com, write us at American Healthcare Alliance, Attn: HIPAA Compliance Coordinator, 9229 Ward Parkway, Suite 300 Kansas City, Missouri 64114, or call us at 816-523-7799 or 800-870-6252.

If you are concerned that your privacy rights may have been violated, or if you disagree with a decision we made about access to your PHI, you may file a complaint with the HIPAA Compliance Coordinator at the above address. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services. Send your complaint to: Medical Privacy, Complaint Division, Office for Civil Rights, United States Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington DC, 20201; or contact the Voice Hotline Number (800) 368-1019; or send the information to their Internet address www.hhs.gov/ocr.

American Healthcare Alliance will not take retaliatory action against you if you file a complaint about our privacy practices.