HIPAA-AS

Privacy

• Explanation of Benefits
• Privacy Practices Notice (PDF)
• Right of Access to Information Under the Privacy Regulation
• Routine Customer Service Inquiries Over the Phone
• Privacy of Members' Medical Information

Explanation of Benefits

The contract holder/policyholder may receive explanations of benefits (EOB's) for all persons covered under the plan.

Right of Access to Information Under the Privacy Regulation

The right to inspect or receive copies of a protected health information (PHI) is limited to the individual who is the subject of the information or a legal personal representative including:

• The natural or adoptive parent of a minor child (unless restricted by court order or custody agreement)
• Executor for a deceased individual
• Court appointed guardian or power of attorney (with authority granted to access health information or make health-related decisions)
• A person named as a personal representative by written authorization from the subject individual

The following are not considered legal personal representatives with regard to the above noted right to access:

• A parent of an adult child (18+)
• A spouse
• A step parent

Regardless of the relationship to the individual, the release of information concerning birth control, alcohol or chemical dependency and mental nervous treatment is subject to specific restrictions and requirements under state and federal law.

Routine Customer Service Inquiries Over the Phone

Persons involved in the care or payment for care for a member are referred to as advocates acting on behalf of a member. A person in this capacity must provide the following information in order to confirm their identity and authority:

• Caller’s name and relationship to the member
• Contract holder’s name and ID number
• Address of the contract holder
• Member or contract holder’s date of birth
• Specific claim detail (if applicable to request)

For example, in order to provide claim status or claim payment information, the caller must be able to verify the name of the provider, date of service, amount of charge and type of service. Regardless of who is calling, we do not release diagnosis or specific procedure information over the phone.

Privacy of Members' Medical Information

Wellmark is required by applicable federal and state laws to maintain the privacy of our members’ medical information. Wellmark is required to give our members notice about our privacy practices, our responsibilities and members’ rights concerning their medical information. The business affairs and records of our company are confidential. They are not to be shared with anyone inside or outside the company, except for those who need to know in order to conduct the business of our company.

The steps Wellmark has taken to safeguard members’ medical information include but are not limited to:

• Disseminated a Privacy Practices Notice to insured members and posted it on wellmark.com
• Disseminated in the provider newsletter Blue Ink, and on wellmark.com, the Wellmark Privacy Practices Notice and other information practitioners and facilities needed to know about Wellmark’s privacy practices
• Established a Privacy Office as a primary point of contact concerning questions or issues regarding privacy matters. We've also established several methods by which people can learn about Wellmark's privacy practices or contact our Privacy Office:

  U.S. Mail
  Wellmark Inc.
  Privacy Office, Station 850
  636 Grand Avenue
  Des Moines, IA 50309-2565

  Telephone
  877-610-6395 Outside Des Moines Area (toll-free)
  515-299-5850 Des Moines Local Area

  Fax
  515-248-5699

  E-mail
  privacyoffice@wellmark.com

• Established internal policies and procedures for compliance with the Privacy Rule disseminated the information to employees through corporate-wide privacy training and department-specific training for customer service and other areas
• As a condition of employment, all members of Wellmark's workforce are required to sign a Confidentiality and Nondisclosure Agreement.
• In daily interaction with members and providers, Wellmark provider and customer service representatives inform providers and members of our procedures to verify identity and authority of callers to discuss protected health information
• Limited physical and information system access to medical information to people who need it to do their jobs
• Strict security regarding access to facility, personal computers and medical information

Copyright© 2008 Wellmark, Inc. All Rights Reserved.
Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.