Overview

Request a copy of PHI (right of access):

You have the right to see and get a copy of PHI that we may use to make decisions about you, such as eligibility information, claims, prescription order information, case management records, or medical management records. You may request all or part of your records. In some cases, you may receive a summary of this health information. You may also request that we provide a copy of your information to a third party that you identify. Requests must be made in writing by you or your personal representative. Do not submit requests for records made for legal purposes, via a subpoena, by third parties, or for ERISA with these forms.

We may charge a nominal fee for copies of your records. In limited circumstances, we may deny your request to inspect a copy of your PHI, in which case you have the right to have the denial reviewed. If we maintain your PHI electronically, you have the right to request that we send a copy in an electronic format to you.

Amend PHI (right to amend):

To request a routine change of address, call customer service at the telephone number located on the ID card for your health or pharmacy benefit plan or update this information through your online account (where applicable). Do not complete a form through this site.

If you believe the PHI we maintain about you is inaccurate or incomplete, you have the right to request an amendment. Requests must be made in writing by you or your personal representative. If we deny the request, you may have a statement of disagreement added to your record.

Receive confidential communications (right to request a confidential communication):

To request a routine change of address, call customer service at the telephone number located on the ID card for your health or pharmacy benefit plan or update this information through your online account (where applicable). Do not complete a form through this site.

You have the right to receive some types of information in a different manner or at a different address (for example, receiving mailings to a P.O. Box instead of your home address). This request type cannot be used to prevent all mailings from going to the individual making the request; it is used for redirection of mailings to an alternative address.

We will accommodate reasonable requests in which a disclosure of all or part of the PHI could endanger you. While we accept verbal requests to put an initial confidential communication in place, requests must be made in writing to modify or cancel a previous confidential communication.

Request restrictions (right to request restriction of uses and disclosures):

You have the right to ask to restrict uses or disclosures of PHI:

• for treatment, payment or healthcare operations; or
• to family members or others who are involved in your healthcare or payment for your healthcare.

Requests must be made in writing by you or your personal representative. We use and disclose member level information only as necessary to provide services to our members and as permitted and required by law. While we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.

Release of Information (ROI) / Authorization for Disclosure of PHI:

For yourself: You may decide to allow a family member or representative to obtain information about you through a ROI/authorization or you may want us to share your PHI with a third party for purposes other than Treatment, Payment, or Healthcare Operations. In order to do so, you will need to authorize the disclosure of your PHI by completing a ROI/authorization form or submitting other legal documentation (such as a Power of Attorney) that establishes that authority.

For someone else: You may be helping someone else such as a spouse, parent, or other adult dependent manage their healthcare information. In order to do so, you must submit an ROI/authorization form completed by the person you are helping, allowing you to make the request and obtain information about them. If you are a guardian, legal representative, or have Medical Power of Attorney for someone and they are unable to sign a ROI/authorization for themselves, you will need to provide a copy of your legal authority to represent them with any request you submit. You do not have to provide copies of these documents if they are already on file with us.

Receive an accounting of disclosures (right to an accounting of disclosures of PHI):

You have the right to receive an accounting of certain disclosures of your PHI made by us during the six years prior to the date of request. Requests must be made in writing by you or your personal representative. This accounting will not include disclosures of information made:

• prior to April 14, 2003;
• for treatment, payment, and healthcare operations purposes;
• to you or pursuant to your authorization; or
• to correctional institutions or law enforcement officials, and
• for which federal law does not require us to provide an accounting.

Submit complaints:

If you believe we have violated your privacy rights or have concerns about our privacy practices, you may file a complaint with the Optum Privacy Office via email to privacy@optum.com. or mail to Optum, Privacy Administrator, MN101-E013, 11000 Optum Circle, Eden Prairie, MN 55344. In addition, you may submit a written complaint to the U.S. Department of Health and Human Services (HHS).

Receive a printed copy of the Notice of Privacy Practices (right to notice):

Where applicable, you have the right to a paper copy of the Notice of Privacy Practices (NPP) and may ask for a copy at any time, even if you previously agreed to receive the notice electronically. If we maintain a website for your particular health plan, you may also obtain a copy of this notice on your health plan website. For NPPs specific to your non-network provider or health plan, contact that entity directly.