This notice describes how information about you and/or your child 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 the Hospital Traveler privacy officer at 866-MED-TRVL.
WHO WILL FOLLOW THIS NOTICE?
This notice describes the privacy practices of patient's related medical and other information generated at Hospital Traveler. This notice applies to Hospital Traveler and that of:
All departments and units of Hospital Traveler.
Any member of a volunteer group we allow to help you and/or your child while being assisted by Hospital Traveler.
All employees, professional staff and other personnel at Hospital Traveler.
* This notice is written using the subject “you and/or your child.” For emancipated minors or patients older than 18 years of age, this notice also applies and, in these situations, “you” should be substituted for “you and/or your child.”
OUR PLEDGE REGARDING MEDICAL AND OTHER INFORMATION :
We understand that medical and other information about you and/or your child is personal. We are committed to protecting medical and other information about you and/or your child. We create a record of the services you and/or your child receives. We need this record to provide care and to comply with certain legal requirements. This notice applies to all of the records of you and/or your child created or maintained by Hospital Traveler. We will also describe your rights and certain obligations we have regarding the use and disclosure of medical and other information.
We are required by law to:
Make sure medical and other information that identifies you and/or your child is kept private;
Give you this notice of our legal duties and privacy practices with respect to medical and other information about you and/or your child; and
Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL AND OTHER INFORMATION ABOUT YOU OR YOUR CHILD:
The following categories describe different ways that we use and disclose medical and other information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
1. For Lodging Services. We may use medical and other information about you and/or your child to provide you and/or your child with lodging services. We may disclose medical and other information about you and/or your child to non-profit organizations, lodging facilities, doctors, nurses, technicians or other personnel at Hospital Traveler (employed or approved by Hospital Traveler to participate in care) who are involved in assisting you and/or your child. For example, your benefits manager may need to contact your doctor to obtain your diagnosis in a letter and/or specified insurance form so we may obtain insurance approval. Different departments at Hospital Traveler also may share medical and other information about you and/or your child in order to coordinate the different things you and/or your child needs, such as lodging, transportation, and meals. We may disclose information about you and/or your child’s care to your applicable doctor identified as a provider of medical care to you and/or your child, even if that doctor is not a direct participant. For example, it is routine for Hospital Traveler to obtain a letter of medical necessity from your physician to prove to the state that you require assistance. Often we must contact the primary care provider (PCP). Finally, Hospital Traveler provides “family-centered” care. Hospital Traveler believes that family support is important. Accordingly, at Hospital Traveler, there are many benefit managers who are active participants in the care of families, and these professionals routinely have access to and document in medical records created at Hospital Traveler.
2. For Payment. We may use and disclose medical and other information about you and/or your child so that services you and/or your child receive through Hospital Traveler may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a procedure you and/or your child received at your medical center so your health plan will pay Hospital Traveler or reimburse you. We also may tell your health plan about a treatment you and/or your child is going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
3. For Healthcare Operations. We may use and disclose medical and other information about you and/or your child for operation purposes. These uses and disclosures are necessary to run Hospital Traveler and make sure all patients receive quality care. For example, we may use medical and other information to review our services and to evaluate the performance of our staff in caring for you and/or your child. We also may combine medical and other information about many Hospital Traveler patients to decide what additional services Hospital Traveler should offer, what services are not needed, and whether certain new services are effective. We also may disclose information to Medicaid, doctors, nurses, technicians, and other Hospital Traveler personnel for review and learning purposes. We also may combine the medical and other information we have with medical and other information from other providers to compare how we are doing and see where we can make improvements in the services we offer. We may remove information that indentures you and/or your child so others may use the medical and other information to study service delivery. Finally, we may share information about you and/or your child with managers or coordinators assisting other individuals at Hospital Traveler if this information could be important to these individuals in order to protect other patients at Hospital Traveler or to comply with the regulations of governmental agencies, such as the Center for Medicaid Services (CMS) or Occupational Safety and Health Administration (OSHA).
4. Hospital Traveler Services. We may use medical and other information about you and/or your child to generate notices of additional services available to you and/or your child at Hospital Traveler.
5. Fundraising Activities. We may use demographic and dates-of service information about you and/or your child to contact you in an effort to raise money for Hospital Traveler and its operations. We only would release contact information, such as your name, address and phone number and the dates you and/or your child received services at Hospital Traveler. If you do not want Hospital Traveler to contact you for fundraising efforts, you must notify the Hospital Traveler privacy officer in writing.
6. The Hospital Traveler Directory. We may include certain limited information about you and/or your child in the Hospital Traveler directory while you and/or your child are being assisted by Hospital Traveler. This information may include you and/or your child’s name and lodging location.
7. Members of the Media. A one-word condition and location of you and/or your child may be released to members of the media only if the inquiry specifically contains you and/or your child’s name. No information will be given to a member of the media if a request does not include you and/or your child’s name.
8. Individuals Involved in You and/or your child’s Care. We may release information about you and/or your child to a friend or family member who is actively involved in you and/or your child’s medical care. We also may release information to someone who helps pay for you and/or your child’s care. This would be the minimum necessary information needed to facilitate payment.
9. Disaster Relief. We may disclose medical and other information about you and/or your child to any entity assisting in a disaster relief effort so that your family can be notified about you and/or your child’s condition, status and location.
10. Research. Under certain circumstances, we may use and disclose medical and other information about you and/or your child for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received our service to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of information, trying to balance the research needs with patients’ needs for privacy of their medical and other information. Before we use or disclose medical and other information for research, the research project will have been approved through this research approval process. We may disclose medical and other information about you and/or your child to people preparing to conduct a research project [preliminary research]. For example, we may allow researchers to review patient records to help them determine if a particular research project will be successful. We always will require that researchers sign a pledge (a legal commitment) to honor the confidential nature of you and/or your child’s medical and other information. For a research project, this pledge will be specific to the project and the information they access. For preliminary research, this will be a general statement regarding their intent to honor the confidential nature of patient information. Finally, it will be a requirement of all approved research studies that any publication of results will only be permitted if there is full deidentifcation of the medical and other information; that is, in no way will it be possible for the reader of the publication to identify you and/or your child with the medical and other information disclosed in the publication.
11. As Required by Law. We will disclose information about you and/or your child when required to do so by federal, state or local law.
12. To Avert a Serious Threat to Health or Safety. We may use and disclose information about you and/or your child when necessary to prevent a serious threat to your health and safety or to the health and safety of others. Any disclosure, however, would only be to someone able to help prevent the threat. For example, if the Emergency department of another hospital calls Hospital Traveler and requires information about you and/or your child to service you and/or your child in an emergency, the necessary information will be released to that Emergency department.
SPECIAL SITUATIONS:
13. Military and Veterans. If you are a member of the armed forces, we may release information about you and/or your child as required by military command authorities. We also may release information about foreign military personnel to the appropriate foreign military authorities.
14. Workers’ Compensation. We may release medical or other information about you and/or your child for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
15. Public Health Risks. We may disclose medical and other information about you and/or your child for public health activities. This may include, but not limited to:
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure when required or authorized by law.
16. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose information about you and/or your child in response to a court or administrative order. We also may disclose information about you and/or your child in response to a subpoena, search warrant, discovery request or other lawful process by someone else involved in the dispute.
17. Law Enforcement. We may release medical and other information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness or missing person;
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct while at the lodging facility; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
18. National Security and Intelligence Activities. We may release information about you and/or your child to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
19. Protective Services for the President and Others. We may disclose medical and other information about you and/or your child to authorize federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.
YOUR RIGHTS REGARDING MEDICAL AND OTHER INFORMATION ABOUT YOU AND/OR YOUR CHILD:
You have the following rights regarding medical and other information we maintain about you and/or your child:
20. Right to Inspect and Copy. You have the right to inspect and obtain a copy of information that may be used to make decisions about you and/or your child’s care. This includes billing records and medical information. To inspect and/or copy information that may be used to make decisions about you and/or your child, you must submit your request in writing to the Records Director at Hospital Traveler (or his/her designee). If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain, very limited circumstances. If you are denied access to information, you may request that the denial be reviewed. Another licensed professional chosen by Hospital Traveler will review your request and the denial. The person conducting the review will not be the person who denied your original request. We will comply with the outcome of the review.
21. Right to Amend. If you feel that information we have about you and/or your child is incorrect or incomplete, you may ask us to change the information. You have the right to request a change for as long as the information is kept by or for Hospital Traveler. To request a change, your request must be made in writing and submitted to the Hospital Traveler privacy officer. In addition, you must provide a sufficient reason to support your request. We may deny your request for a change if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the change;
Is not part of the information kept by or for Hospital Traveler;
Is not part of the information which you would be permitted to inspect and copy; or
Is already accurate and complete.
22. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical and other information about you and/or your child. Exceptions: Disclosures as a result of a valid authorization and disclosure to individuals made as part of activities 1 to 13, 23, above are not tracked (every therapist, nurse, etc.involved in you and/or your child’s care; every audit of care provided, etc.) and will not, therefore, be included in the accounting of disclosures provided to you. To request this list or accounting of disclosures, you must submit your request in writing to the Hospital Traveler Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before January 1, 2006. The first list you request within a 12-month period will be free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost prior to providing the list, and you may choose to withdraw or modify your request at that time—before any costs are incurred.
23. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical and other information we use or disclose about you and/or your child. You also have the right to request a limit on the medical and other information we disclose about you and/or your child to someone who is involved in you and/or your child’s care or who pays for you and/or your child’s care, such as a family member or friend. For example, you could ask that we not use or disclose information about your service you and/or your child had to a specific family member who is not a legal guardian. We are not required to agree to your request. In particular, we will not agree if we have any concern that this could compromise our ability to provide appropriate care to you and/or your child. Also, we cannot agree to deny access to your child’s records by a parent, legal guardian or the child himself, if the child is older than age 18. If we agree with your request, we reserve the right to take back our agreement in order to protect you and/or your child. To request restrictions, you must make your request in writing to the Hospital Traveler Privacy Officer. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; (3) to whom you want the limits to apply.
24. Right to Request Confidential Communications. You have the right to request that we communicate with you about you and/or your child’s medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will make reasonable efforts to comply. We reserve the right to take back our agreement should we feel this is necessary to protect you and/or your child. To request confidential communications, you must make your request in writing to the Hospital Traveler Privacy Officer. We will not ask you the reason for your request. We will make reasonable efforts to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
25. 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.hospitaltraveler.com, or to obtain a paper copy of this notice, contact the Hospital Traveler Privacy Officer.
CHANGES TO THIS NOTICE:
26. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical and other information we already have about you and/or your child, as well as any information we receive in the future. We will post a copy of the current notice at Hospital Traveler.com. The notice will contain on the last page, in the bottom left-hand corner, the effective date. In addition, each time you and/or your child registers for Hospital Traveler assistance or services, we will offer you a copy of the current notice in effect.
COMPLAINTS:
If you believe your privacy rights have been violated, contact a Hospital Traveler representative to assist you in filing a written complaint to the Privacy Officer. Alternatively, you may submit a complaint in writing by mail to the Hospital Traveler privacy officer using the address of Hospital Traveler. You also may file a complaint with the Secretary of the Department of Health and Human Services. Neither you nor you and/or your child will be penalized in any way for filing a complaint. |
