Privacy Practices

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. You may ask for a separate paper copy of this privacy notice at any time. Para recibir esta noticia en español llame al 800-346-4643. TTY 800-704-6370.

In this notice, the words "us" or "we" means Rocky Mountain Health Plans (RMHP), which includes plans underwritten by Rocky Mountain HMO and Rocky Mountain HealthCare Options.

Why is this notice provided?
RMHP respects the privacy of your personal health information (PHI). We are required by law to make sure that your PHI is kept private. We must give you this notice of our legal duties and privacy practices with respect to your PHI.

What is PHI?
PHI includes information that we have about your past, present, or future health or medical condition that could be used to identify you. It includes information about such things as eligibility, medical treatment, or payment for health care you have received.

How and when can you use or give out (disclose) my PHI?

To help make sure your medical bills sent to us for payment are handled correctly.
To doctors or other providers to help them provide medical care to you, such as coordinating care between your primary care physician and a specialist.
To help providers manage your health care, such as if you're in a wellness program.
To send you a reminder if you have an appointment with your doctor.
To give you information about alternative medical treatments and programs. To tell you about health related products and services that you may be interested in, such as a weight loss program.
To an employer that provides your health benefits, such as confirming enrollment information.
To others if you agree or if you are unable to agree, such as if a home health nurse visits you at your home. If your spouse is with you, we may discuss your PHI with you both.

There are also state and federal laws that may require us to give your PHI to others. For example, we may give out your PHI for the following reasons:

To state and federal agencies that regulate us (such as the US Department of Health and Human Services and the Colorado Division of Insurance).
For public health activities (such as reporting disease outbreaks).
To public health agencies if we believe there is a serious health or safety threat.
For government health oversight activities (such as fraud investigations).
To a court or administrative agency (such as to obey a court order).
For law enforcement purposes (such as to locate a suspect).
To a government authority regarding abuse, neglect, or domestic violence.
To a coroner, medical examiner, or funeral director, such as for determining cause of death.
For getting, saving, or transplanting organs, eyes, or tissue; and in limited ways, for research activities.
For special government functions, such as for national security.
For job-related injuries because of state worker compensation laws.

If none of the above reasons apply, we must get your written permission. Click here to download a copy of the Authorization to Use or Disclose Specific Information form, necessary for RMHP to use or give out your PHI. If you give us written permission and then change your mind, you may take back (revoke) your written permission at any time. However, you cannot take back your written permission if we already acted when we had it.

What are my rights with respect to my PHI?
You have the right to ask that we limit how we use and give out your PHI. You also have the right to request how much PHI we give to someone who is involved in your care or helping pay for your care. Please note that we are not required to agree to the request.

You have the right to ask that we communicate with you in a different way or at a different place in order to protect you from danger. For example, you may ask us to send PHI to your work address instead of your home address. You have the right to see and get a copy of your PHI that we have. You may ask for a summary of PHI we have about you. We will respond to you within 30 days after we receive your written request. If we deny your request, we will tell you, in writing, the reasons why. We will also explain your right to have our denial reviewed. We may charge you a reasonable fee based on the cost of copying and postage or preparing the summary.

You have the right to get a list of instances in which we have given out your PHI during the six years prior to your request. Please note that we are not required to give you a list of every time we gave out your PHI. We do not have to tell you times we gave out your PHI:

Before April 14, 2003.
For treatment, payment, and health care operation purposes.
To you or others, if we have your written permission.
To persons involved in your care or payment for care.
For national security reasons or in special situations required by law enforcement or health oversight agencies.

We will act on your request within 60 days. Your first list will be free. We will give you one free list every 12 months if you ask for it. If you ask for another list within 12 months of getting your free list, we may charge you a fee.

You have the right to ask us to correct your PHI or add missing information if you think there is a mistake in your PHI. We will respond within 60 days of receiving your written request. If we deny your request, we will tell you the reasons in writing. Our written denial will also explain your right to file a written statement of disagreement. You have the right to ask us to attach your request, our denial, and your statement of disagreement to your PHI anytime we give it out in the future.

You have the right to get a separate written copy of this notice anytime you ask for it.

If I want to use these rights, do I have to make a written request?
Yes. All requests must be made in writing. You can get a request form and send in your request by using the contact information at the end of this notice.

How may I complain about your privacy practices?
Send your written complaint to RMHP Customer Service, Attn: Privacy, PO Box 10600, Grand Junction, CO 81502-5600. You also may complain to the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint about our privacy practices or using any of the rights described in this notice.

How will I know if my rights described in this notice change?
We follow the terms of the notice that is currently in effect. This notice is effective April 14, 2003. We reserve the right to change the terms of this notice and our privacy policies at any time. Then the new notice will apply to all your PHI. If we change this notice, we will put the new notice on our website and mail a copy of the new notice to our subscribers.

Who should I contact to get more information, to get a copy of this notice, or to obtain request forms?

Visit our website at www.rmhp.org

Write us:
Rocky Mountain Health Plans
PO Box 10600
Grand Junction, CO 81502-5600

Call RMHP Customer Service at 800-346-4643, or TTY 800-704-6370