THIS NOTICE DESCRIBES HOW MEDICAL AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL AND FINANCIAL INFORMATION IS VERY IMPORTANT TO US
At Lake Washington Wellness, we are committed to maintaining the confidentiality of your medical and financial information, which we refer to as your personal information. This Notice of Privacy Practices informs you about how we may collect, use and disclose your personal information and your rights regarding that information. This Notice pertains to you and your covered dependents. Please share it with your covered dependents.
OUR RESPONSIBILITIES TO PROTECT YOUR PERSONAL INFORMATION
We are required by law to: Protect the privacy of your personal information; provide this Notice explaining our duties and privacy practices regarding your personal information; and abide by the terms of this Notice.
HOW WE MAY COLLECT YOUR PERSONAL INFORMATION
We collect most of your personal information directly from you. When billing your insurance company we require certain information from you to file your claims. We may also obtain your personal information from third parties without your specific authorization. These third parties may include your insurance company, employers, health care providers, other health plans or insurers, and state and federal agencies.
HOW WE MAY USE AND DISCLOSE YOUR PERSONAL INFORMATION
We may use or disclose your personal information without your specific authorization for the purposes described below. For other purposes, we will request your specific authorization in writing, which you may grant or reject. If granted, you can revoke the authorization at any time by letting us know in writing.
Treatment: We may disclose personal information about you that your physician or other health care provider requests to help them with your medical treatment or services.
Payment: We may use and disclose personal information so that we can process your medical claims. For example, we may need to disclose personal information to coordinate benefits with other health plans, to determine coverage and to get your claims processed. However, state laws may prohibit us from disclosing certain types of sensitive personal information about you to other members of your family without your specific authorization.
Health Care Operations: We may use and disclose personal information for health plan operations. For example, we may disclose personal information to conduct quality assessment and improvement activities, to engage in care or case management. However, state laws may prohibit us from disclosing certain types of sensitive personal information about you to other members of your family without your specific authorization.
Business Associates: We may disclose your personal information to our Business Associates, which are entities or individuals that are not employed by us that perform health care operations or payment activities on our behalf which requires the collection, use or disclosure of your personal information. We must have contracts with our business associates that require them to maintain the confidentiality of your personal information. For example, we may contract with a billing service to help us in the processing of our claims.
Appointment/Service Reminders: We may use your personal information to contact you to remind you of a scheduled appointment.
Individuals Involved in Your Care or Payment for Your Care: We may disclose personal information about you to an immediate family member, or other individuals who are directly involved in your care or payment for your care.
As Required by Law:We may use or disclose your personal information when required by federal, state or local law. For example, we may disclose personal information to a health oversight agency, to include the Secretary of the Department of Health and Human Services or a state insurance department, for activities such as audits, investigations, or related to licensure. If you receive public benefits through a government program, we may disclose personal information about you to the state or federal agency administering that program or another government program, including workers compensation programs.
Public Health and Safety:We may disclose personal information about you to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others.
Legal Proceedings: We may disclose your personal information in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Law Enforcement:We may disclose your personal information to law enforcement officials if we receive a court order, warrant, grand jury subpoena or an inquiry for purposes of identifying or locating a suspect, fugitive, material witness or missing person. If you are an inmate, we may disclose your personal information to correctional institutions as allowed by law.
Military and National Security:Under certain circumstances, we may disclose to military authorities the personal information of armed forces personnel. We may also disclose to authorized federal officials personal information required for lawful intelligence, counterintelligence and other national security activities.
YOUR RIGHTS REGARDING PERSONAL INFORMATION
You have the following rights regarding personal information that we maintain about you.
Inspection: You have the right to request inspection and to receive a copy of a record of your personal information.
Amendment: If you feel the personal information that we maintain about you is incorrect or incomplete, you have the right to request amendment to your personal information.
Restriction Request: You have a right to request a restriction or limitation on the personal information we use or disclose about you for treatment, payment and health care operations activities or disclosures to individuals involved in your care.
Confidential Communications: If you believe that disclosure of all or part of your personal information may endanger you, you have the right to request that we communicate with you about health matters at an alternative location. For example, you may ask that we only contact you at your work address.
Accounting of Disclosures:
You have the right to an accounting of disclosures we have made for purposes other than for treatment, payment, health care operations, or that you specifically authorized. Your request may be for disclosures made up to 6 years before the date of your request, but not for disclosures made before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of copying, mailing, and supplies associated with your request.
All of these requests must be made in writing. Please contact us at the phone number below. Except for accounting of disclosures, we will evaluate each request and communicate to you in writing whether or not we can honor the request. There are instances when we cannot honor your request. For example, we will not amend personal information that was not created by us unless the person or entity that created the information is no longer available to make the amendment. We may also charge a reasonable fee for the costs of copying, mailing and supplies associated with your inspection and amendment requests.
CHANGES TO THIS NOTICE
Should any of our privacy practices change, we reserve the right to change the terms of this Notice. The revised notice would apply to all the personal information about you that we maintain. If we make any changes to our privacy practices, you will find the revisions on our website at wwwlakewashingtonwellness.com. If you need a copy of this Notice or want more information about our privacy practices, contact us as described below.
If you receive this Notice on our website or by electronic mail (e-mail), you are also entitled to receive this Notice in paper form. To obtain a paper copy of this Notice, contact us as described below.
REPORTING A PROBLEM
If you believe your privacy rights have been violated, or if you disagree with a decision we made about a request, you may file a written complaint with us or the Secretary of the Department of Health and Human Services (DHHS). You will not be penalized if you file a complaint about our privacy practices with us or with DHHS.
Lake Washington Wellness
15965 NE 85th St. Suite#102, Redmond, WA 98052
Phone (425) 882-9065
Fax (425) 558-1900