Banner MediSun Privacy Notice
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.
Effective Sept. 1, 2008
At Banner MediSun, we respect the confidentiality of your health information and will protect your information in a responsible and professional manner. We are required by law to maintain the privacy of your health information and to send you this notice.
This notice explains how we use information about you and when we can share that information with others. It also informs you of your rights with respect to your health information and how you can exercise those rights.
When we talk about “information” or “health information” in this notice we mean the following:
- Information we receive directly or indirectly from you through enrollment/disenrollment forms, surveys, or other forms, in writing, in person, by telephone, or electronically (such
as name, address, telephone number, and other demographic data). - Information about your transactions with us, our affiliates, our agents and others (such as medical history, health treatment, services and prescriptions, referrals to other medical
providers, health care claims and encounters, premium and payment information, service requests, and grievance & appeals information).
HOW WE USE OR SHARE INFORMATION
The following are ways that we may use or share information about you:
- We may use the information to help pay your medical bills that have been submitted to us by doctors and hospitals for payment.
- We may share your information with your doctors and hospitals to help them provide medical care to you. For example, if you are in the hospital, we may give them access to any medical records sent to us by your doctor.
- We may use or share your information with others to help manage your health care. For example, we might talk to your doctor to suggest a disease management or wellness
program that could help improve your health. - We may share your information with others who help us conduct our business operations. Some examples include consultants, lawyers and delegated entities. We will not share
your information with outside groups unless they agree to keep it protected. - We may use or share your information in the process of the routine operations. Examples include quality assurance, utilization review, prior authorization, case management,
pharmacy benefit management, internal audit, credentialing/recredentialing or other
routine operational activities. - We may share limited information, such as your name and address, with the Sun Health Foundation in order to distribute materials designed to support Banner Health’s nonprofit
health care services. - We may disclose your information to a spouse, family member or authorized representative who is involved in your medical care or who helps to pay for your health care.
- We may use or share your information for certain types of public health or disaster relief efforts.
- We may report information as required by state and federal law under statute, regulation, or court opinion including mandatory licensing, regulatory compliance and reporting, auditing, and court subpoena.
- We may report information on job-related injuries because of requirements of the state worker compensation laws.
If one of these reasons does not apply, we must get your written permission to use or disclose your health information. If you give us written permission and change your mind, you may revoke your written permission at any time.
We will make all reasonable efforts to limit the use or disclosure of, and requests for protected health information to the minimum amount necessary to accomplish the intended purpose.
WHAT ARE YOUR RIGHTS
The following are your rights with respect to your health information. If you would like to exercise the following rights, please contact us in writing at Banner MediSun Member Services 13950 W. Meeker Blvd., Sun City West, AZ 85375. You will receive an acknowledgement of receipt of your request.
- You have the right to ask us to restrict how we use or disclose your information for treatment, payment, or health plan operations. You also have the right to ask us to restrict
information that we have been asked to give to family members or to others who are involved in your health care or payment for your health care. Please note that while we will try to honor your request, we are not required to agree to these restrictions. - You have the right to ask to receive confidential communications of information. For example, if you believe that you would be harmed if we send your information to your
current mailing address (for example, in situations involving domestic disputes or violence), you can ask us to send the information by alternative means (for example, by fax) or to an alternative address. We will accommodate your reasonable requests as explained above. - You have the right to inspect and obtain a copy of certain information that we maintain about you in your designated record set. A “designated record set” is the file that contains your personal information (such as your name, address, telephone number and other demographic information), your financial information (such as information related to payment of plan cost sharing) and medical information (such as information you have provided to us through survey responses, information gathered through claims payment, and information provided by physicians that request authorization of medical
care or drugs). - You have the right to request an accounting of certain non-routine and public policy disclosures of information that we maintain about you in your designated record set. We will provide you with an accounting of these types of disclosures within 60 days of receipt of your request (we may require a 30- day extension but will provide you with a written statement of the reason for the delay). The accounting will include non-routine
and public policy disclosures made in the previous 6 years (but not prior to 4/14/2003). You are entitled to receive one accounting of disclosures every 12-months free of charge;
any additional requests will be subject to a fee. We will inform you in advance of the fee and provide you with the opportunity to withdraw or modify your request. - You have the right to request that the information contained in your designated record set be amended. We will send you a written statement within 60 days of receipt of your request (we may require a 30-day extension but will provide you with a written statement of the reason for the delay) telling you if your record will be amended as requested. We can deny your request for an amendment if the record is complete and
accurate. You may submit a written disagreement if we deny your request to amend the record. Your request to amend the record, our response to your request, your written
disagreement, and our rebuttal will be retained as a part of your designated record set.
EXERCISING YOUR RIGHTS
Maricopa County) or TTY (800) 367-8939 (strictly reserved for the hearing impaired with special telecommunications equipment). The office is open Monday through Friday from 8 a.m. to 5 p.m. You can also send us questions by e-mail.
If you believe your privacy rights have been violated, you may file a complaint with us by writing to Banner MediSun Attn: Compliance Department, P.O. Box 1489 Sun City, AZ 85372. You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.