Notice Of My Policies and Privacy Practices
Good Faith Estimate Notice – as required by CMS
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises or call 1-800-985-3059.
You have the right to:
- Get a copy of your health and claims records.
- Correct your health and claims records.
- Request confidential communication.
- Ask me to limit theinformation I share.
- Get a list (with someexceptions) of those with whom I have shared your information.
- Get a copy of this privacy notice.
- Choose someone to act for you.
- File a complaint if you believe your privacy rights have been violated.
You can tell me your choices about certain health information I use or share.
For example, how I:
- Answer coverage questions from your family and friends.
- Provide disaster relief.
I do not market our services or sell your information.
My uses and disclosures
I may use and share your information for these reasons:
- Help manage the health care treatment you receive.
- Run our organization.
- Pay for your health services. Administer your health plan.
- Help with public health and safety issues.
- Do research.
- Comply with the law.
- Address workers’ compensation, law enforcement, and other government requests.
- Respond to lawsuits and legal actions.
- Identify quality improvement opportunities.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your health and claims records.
- You can ask, in writing, to see or get a copy of your health and claims records and some other health information we have about you. Ask me how to do this.
- I will provide a copy or a summary of your health and claims records, usually within 30 days of your request. I may charge a reasonable, cost-based fee. There are some records we do not need to give you.
Ask us to correct health and claims records
- You can ask me, in writing, to correct your health and claims records if you think they are incorrect or incomplete. This applies to certain records, such as those I use to make decisions about you. Ask me how to do this.
- I may say “no” to your request, but I’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- I will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not
Ask me to limit what we use or share
- You can ask me not to use or share certain health information for treatment, payment, or our operations.
- I am not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times I’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). I’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. I will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- I will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
If you believe your privacy rights have been violated or you have questions:
- Contact HCA’s privacy officer by calling 1-844-284-2149 or writing to HCA Privacy Officer, Health Care Authority, P.O. Box 42704, Olympia, WA 98504-2700. OR
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting the Department of Health and Human Services Filing a HIPAA Complaint web page.
- We will not retaliate against you for filing a complaint.
For certain health information, you can tell me your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to me. Tell me what you want us to do, and I will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in payment for your care.
- Share information in a disaster relief situation.
Our uses and disclosures
How do I typically use or share your health information? I typically use or share your health information in the following ways.
Help manage the health care treatment you receive
- I can use your health information and share it with professionals who are treating you.
Example: A doctor, treatment center or referring therapist sends me information about your diagnosis and treatment plan so we can coordinate services.
Run our organization
- I can use and disclose your information to run my practice and contact you when necessary.
Example: We use health information about you to develop better services for you.
Pay for your health services
- I can use and disclose your health information as we pay for your covered health services.
Example: I might share information about you with your doctor to coordinate payment for your therapy.
- If you ask for an administrative hearing to review a denial, we usually have to disclose information in the hearing process.
How else can we use or share your health information?
I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.
I have to meet many conditions in the law before I can share your information for these purposes.
For more information, visit the Department of Health and Human Services HIPAA webpage.
Help with public health and safety issues
I can share health information about you for certain situations such as:
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone’s health or safety.
- I can use or share your information for health research.
Comply with the law
- I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Address workers’ compensation, law enforcement, and other government requests
I can use or share health information about you:
- For workers’ compensation claims.
- For law enforcement purposes or with a law enforcement official.
- With health oversight agencies for activities authorized by law.
- For special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
- I can share health information about you in response to a court or administrative order, or in response to a subpoena.
Are there specially protected types of information?
Yes, some types of information have greater protection under Washington State or federal laws. The above disclosure practices don’t necessarily apply to these types of information, which include confidential HIV-related information that is protected by Washington State laws; alcohol and substance abuse treatment information that is protected under both Washington State and federal laws; and mental health treatment information that is protected.
- I am required by law to maintain the privacy and security of your protected health information.
- I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- I must follow the duties and privacy practices described in this notice and give you a copy of it if you ask.
- I will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let me know in writing if you change your mind.
For more information, visit the Department of Health and Human Services Notice of Privacy Practices web page.
Changes to the terms of this notice. I can change the terms of this notice, and the changes will apply to all information we have about you. I will give you the new notice, or tell you about it and how to get a copy. The revised notice will be available on our web site, and we will email or mail a copy to you on request.