Effective: April 14, 2003

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.

IEHP provides health care to you through the Medi-Cal
program and other State and Commercial programs. 
We are required by state and federal law to protect
your health information.  And we must give you this
Notice that tells how we may use and share your
information and what your rights are.

Your information is personal and private.

We receive information about you from Medi-Cal and
other State and local agencies after you become
eligible and enroll in our health plan.  We also
receive medical information from your doctors,
clinics, labs, and hospitals in order to approve
and pay for your health care.

CHANGES TO NOTICE OF PRIVACY PRACTICES

IEHP must obey the Notice currently in effect. We have the right to change these privacy practices. If we do make changes after April 14, 2003, we will revise this Notice and send it to you right away.

HOW WE MAY USE AND SHARE INFORMATION ABOUT YOU

Your information may be used or shared by IEHP only
for a reason directly connected to the Medi-Cal
Program or the particular program in which you are
enrolled.  The information we use and share includes,
but is not limited to:

• Your name,
• Address,
• Personal facts,
• Medical care given to you, and
• Your medical history.

Some actions we take when we act as a Health Plan include:

• Checking your eligibility, enrollment, and amount of medical aid,
• Approving, giving, and paying for Medi-Cal services,
• Investigating or prosecuting Medi-Cal cases (like fraud).
• Checking the quality of care that you receive.
• Coordinating the care you receive

Some Examples:

1. For treatment: You may need medical treatment that requires us to approve care in advance. We will share information with doctors, hospitals and others in order to get you the care you need.

2. For payment: IEHP reviews, approves, and pays for health care claims sent to us for your medical care. When we do this, we share information with the doctors, clinics, and others who bill us for your care. And we may forward bills to other health plans or organizations for payment.

3. For health care operations: We may use information in your health record to judge the quality of the health care you receive. We may also use this information in audits, fraud and abuse programs, planning, and general administration.

OTHER USES FOR YOUR
HEALTH INFORMATION

1. Sometimes a court will order us to give out your health information.  We will also give information to a court, investigator, or lawyer if it is about the operation of the Medi-Cal Program or one of our other programs.  This may involve fraud or actions to recover money from others, when Medi-Cal or IEHP has paid your medical claims.

2. You or your doctor, hospital, and other health care providers may appeal decisions made about claims for your health care.  Your health information may be used to make these appeal decisions.

3. We may also share your health information with agencies and organizations, which check how our health plan is providing services.

4. We must share your health information with the federal government when it is checking on how we are meeting privacy rules.

WHEN WRITTEN
PERMISSION IS NEEDED

If we want to use your information for any purpose not listed above, we must get your written permission. If you give us your permission, you may take it back in writing at any time.

WHAT ARE YOUR PRIVACY RIGHTS?

• You have the right to ask us not to use or share your personal health care information in the ways described above. We may not be able to agree to your request.

• You have the right to ask us to contact you only in writing or at a different address, post office box, or by telephone. We will accept reasonable requests when necessary to protect your safety.

• You and your personal representative have the right to get a copy of your health information. You will be sent a form to fill out and may be charged a fee for the costs of copying and mailing records. (We may keep you from seeing certain parts of your records for reasons allowed by law.)

• You have the right to ask that information in your records be amended if it is not correct or complete. We may refuse your request if:
  o The information is not created or kept by IEHP, or
  o We believe it is correct and complete.

• If we don’t make the changes you ask, you may ask that we review our decision. You may also send a statement saying why you disagree with our records and your statement will be kept with your records.

IMPORTANT

IEHP DOES NOT HAVE COMPLETE COPIES OF YOUR MEDICAL RECORDS. IF YOU WANT TO LOOK AT, GET A COPY OF, OR CHANGE YOUR MEDICAL RECORDS, PLEASE CONTACT YOUR DOCTOR OR CLINIC.

• When we share your health information after April 14, 2003, you have the right to request a list of:
  o Whom we shared the information with,
  o When we shared it,
  o For what reasons, and
  o What information was shared.

This list will not include when we share information with you, with your permission, or for treatment, payment, or health plan operations.

You have a right to request a paper copy of this Notice of Privacy Practices.

HOW DO YOU CONTACT US TO USE YOUR RIGHTS?

If you want to use any of the privacy rights explained in this Notice, please call or write us at:
IEHP Privacy Officer
INLAND EMPIRE HEALTH PLAN
P.O. Box 19026
San Bernardino, CA 92423-9026
(909) 890-2000

COMPLAINTS

If you believe that we have not protected your privacy and wish to complain, you may file a complaint (or grievance) by calling or writing:
IEHP
P.O. Box 19026,
San Bernardino, CA 92423-9026
(909) 890-2000.

OR you may contact the agencies below:

Privacy Officer
CA Department of Health Services
P.O. Box 942732
Sacramento, CA 94234-7320
(916) 255-5259 or
(877) 735-2929 TTY/TDD

Or

Secretary of the U.S. Department of Health and Human Services
Office for Civil Rights
Attention: Regional Manager
50 United Nations Plaza, Room 322
San Francisco, CA 94102

For additional information, call (800) 368-1019
or U.S. Office for Civil Rights at (866) OCR-PRIV (866-627-7748) or (866) 788-4989 TTY

USE YOUR RIGHTS WITHOUT FEAR

IEHP cannot take away your health care benefits or do anything to hurt you in any way if you choose to file a complaint or use any of the privacy rights in this Notice.

QUESTIONS

If you have any questions about this Notice and want further information, please contact us at IEHP Privacy Officer, IEHP, at the address and phone number above.