THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
PLEASE REVIEW CAREFULLY. EFFECTIVE DATE JUNE 01, 2020.
NOTICE OF PRIVACY PRACTICE:
Avalon Health Services, LLC, d/b/a Avalon Healthcare Solutions and its wholly owned subsidiaries (collectively “Avalon”) works with your health plan to manage your laboratory benefits. Avalon is committed to protecting the privacy of health information. “Protected Health Information,” or “PHI,” includes information regarding laboratory tests and orders for laboratory tests as well as payment information for the healthcare services provided to you. This Notice applies to all the records of your care generated or maintained at Avalon. This Notice is provided to inform you about: (i) the ways Avalon may use and disclose PHI; (ii) your rights regarding PHI; and (iii) obligations Avalon has, regarding the use and disclosure of PHI.
OUR RESPONSIBILITIES:
Avalon is required by law to maintain the privacy of your PHI and to provide you this Notice of our legal duties and privacy practices and your rights concerning your PHI. It describes our legal duties, privacy practices and your patient rights as determined by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Avalon is required to notify affected individuals in the event of a breach involving unsecured PHI. PHI is stored electronically and is subject to electronic disclosure. Avalon reserves the right to change the terms of this Notice and its privacy policies at any time, provided such changes are permitted under applicable law. Any changes will apply to the PHI Avalon already has; Avalon will promptly post any new or amended versions of this Notice to the website avalonhcs.com.
PRIVACY AND DATA PROTECTION:
Avalon only shares PHI when it is necessary to carry out the treatment, payment for healthcare items or services ordered or rendered on your behalf, health care operations, or as permitted by applicable law. Depending on the test you receive and providers you select, the PHI Avalon receives about you could include information about your healthcare treatment, laboratory tests, mental health, sexually transmittable diseases (including HIV and AIDS), alcohol and substance abuse, as well as other information that may be subject to additional confidentiality provisions of federal or state law.
If an applicable state privacy law is more protective of your health information or is more restrictive than HIPAA, we will follow the applicable state law.
HOW AVALON MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following are some descriptions and examples of different ways Avalon may use and disclose PHI. Not every use or disclosure of PHI is listed below; however, all the ways Avalon is permitted to use and disclose information will fall within one or more of these categories.
Treatment.
Avalon may use PHI to provide you or your health plan prior authorization/utilization management services, case management support, and services related to associated claims. Avalon may disclose PHI to, and obtain information from, doctors, nurses, medical technicians, laboratory test providers, health plans, and other health care personnel who are involved in your care. For example, a doctor testing you for high cholesterol may need to know if you have diabetes because some cholesterol medications affect blood sugar results. Different departments of Avalon also may share PHI in order to coordinate the tests, care, and treatment you need. Avalon also may disclose PHI about you to people outside Avalon who may be involved in your medical care, such as family members, or others used to provide services that are part of your care. Payment. Avalon may use and disclose PHI in order for the treatment and services you receive to be billed and paid. For example, Avalon may need to give your health plan information about tests you received so that your health plan will pay for the services. Avalon may also tell your health plan about a treatment you are planning to receive in order to obtain prior approval or to determine whether it is a covered service under your insurance policy. Health Care Operations. Avalon may use and disclose PHI for health care operations purposes, and for the proper administration and management of Avalon. This category of uses and disclosures enables Avalon to run itself and interact appropriately with others, including to help ensure that quality care is received. For example, Avalon may use and disclose PHI to: (i) review treatment and services and to evaluate the performance of staff in caring for you; (ii) compile data to decide what additional services Avalon should offer, what services are not needed, and whether certain new treatments or tests are effective; (iii) educate doctors, nurses, medical technicians, health plan personnel, and Avalon personnel; and (iv) to prepare Avalon statistical data to analyze company performance, services, and quality of care. As Permitted By Law. Avalon may disclose PHI when permitted to do so by federal, state, or local law. To Avert a Serious Threat to Health or Safety. Avalon may use and disclose PHI when necessary to prevent or lessen a serious threat to your health or safety or the health or safety of the public or another person. Workers Compensation. Avalon may release PHI for workers’ compensation or similar programs upon your consent or as authorized by applicable law. Public Health Purposes. Avalon may disclose PHI for public health activities, including: (i) preventing or controlling disease, injury, or disability, including during a public health emergency such as a global pandemic; (ii) reporting births and deaths; (iii) reporting reactions to medications or problems with products; (iv) notifying people of recalls of products they may be using; or (v) notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading an infectious disease or condition of public health significance, subject to applicable law.
Victims of Abuse.
Avalon may disclose PHI to notify the appropriate government authority if Avalon believes an individual has been the victim of abuse, neglect, or domestic violence. Avalon will only make this disclosure if you agree or when required or authorized by law. Health Oversight Activities. Avalon may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. Avalon may also disclose PHI to federal and state agencies that regulate licenses of nurses and other health care professionals.
Business Associates.
Avalon may disclose information to Avalon Business Associates, who are other companies or individuals that provide services for, or on behalf of, Avalon. These companies and individuals are known as “business associates” and are required to maintain the privacy and security of PHI. For example, we may provide information to an outside medical management agency to assist with a prior authorization or preservice review request.
Health Information Networks, Organizations and Exchanges.
Avalon may disclose PHI to, or obtain PHI from, regional health information organizations and similar networks, which are sometimes called “RHIOs”, for the purpose of treatment, payment, and health care operations. RHIOs are electronic health information systems that Avalon and other health care providers may participate in to facilitate providing care for you. Information contained in RHIOs may also be analyzed to improve the health care operations of Avalon and other participating facilities.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, Avalon may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process. Depending on the nature of the dispute, someone else involved in the dispute may have a valid reason to obtain your PHI. The disclosure will be made, if compelled to do so under applicable law, or after Avalon receives satisfactory assurance that a reasonable effort has been made either to give you notice of the request or to secure a qualified protective order.
Law Enforcement.
Avalon may release PHI to law enforcement: (i) in response to a court or administrative order, subpoena, warrant, summons, or similar process; (ii) to report certain types of wounds or other physical injuries; (iii) to identify or locate a suspect, fugitive, material witness, or missing person; (iv) about the victim of a crime if, under certain limited circumstances, Avalon is unable to obtain the person’s agreement; (v) about a death Avalon believes may be the result of criminal conduct; (vi) about criminal conduct at Avalon; or (vii) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
Coroners or Medical Examiners.
Avalon may release PHI to a coroner or medical examiner for the purposes of identifying a deceased person or determining the cause of death. Avalon may also release PHI to funeral directors as necessary to carry out their duties. National Security and Intelligence Activities. Avalon may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, Avalon may release certain PHI to the correctional institution or law enforcement official in accordance with law. This release would be necessary: (i) for the institution to provide you with health care; (ii) to protect your health and safety or the health and safety of others; or (iii) for the safety and security of the correctional institution.
Parents or Legal Guardians.
Parents and Legal Guardians retain the rights and duties as specified by law. If you are a minor with special healthcare needs or an adult with special needs under a legal guardianship, Avalon may release your PHI to your parents or legal guardians, as applicable, when permitted or required to do so under federal and applicable state law.
OTHER USES OF MEDICAL INFORMATION:
Other uses and disclosures of PHI not covered by this Notice or the laws that apply to Avalon will be made only with your written authorization. You may revoke your written authorization at any time by delivering a written revocation to the Privacy Office. If you revoke your authorization, Avalon will no longer use or disclose PHI about you for the reasons covered by your written authorization. You understand that Avalon is unable to take back any disclosures Avalon has already made, and that Avalon is required to retain records of the care provided to you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You may exercise the following rights by submitting a written request to Avalon’s Privacy Officer. Please be aware, however, that Avalon may deny your request, if legally permitted to do so.
Right to Inspect and Copy.
In most circumstances, you have the right to inspect and copy PHI that may be used to make decisions about your care. Avalon will notify your health plan of a request to inspect and copy. If Avalon maintains an electronic health record containing your PHI, you have the right to request that Avalon send a copy of your PHI to you or to a third party you identify.
Right to Amend.
If you feel that PHI Avalon has about you is incorrect or incomplete you have the right to ask Avalon to amend the PHI for as long as the PHI is maintained by or for Avalon. Avalon will notify your health plan of a request to amend your PHI. Avalon may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, Avalon may deny your request if you ask Avalon to amend information that: (i) was not created by Avalon, unless the person or entity that created the information is no longer available to make the amendment; (ii) is not part of the PHI kept by or for Avalon; (iii) is not part of the information which you would be permitted to inspect and copy; or (iv) is accurate and complete.
Right to an Accounting of Disclosures.
You have the right to request an accounting of disclosures. Avalon will notify your health plan of the request for an accounting of disclosures. This is a list of Avalon’s disclosures of your PHI. The list will not include any of the uses and disclosures for treatment, payment, and health care operations or for certain other limited reasons. Your request must state a time period that is not longer than six years prior to the date of your request and that does not include dates before November 1, 2015 (i.e., when Avalon began providing services). Your request should indicate whether you want the list in hard copy or electronically. The first list you request within a 12-month period will be free. Avalon may charge you for the cost of providing additional lists. Avalon will notify you of the cost involved, and you may withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions.
You have the right to request a restriction or limitation on PHI Avalon uses or discloses about you. Avalon will notify your health plan of the request to restrict or limit PHI. You also have the right to request a limit on PHI Avalon discloses about you to someone who is involved in your care or the payment for your care, like a family member or a friend. Avalon is not required to agree to your request unless the restriction is for a disclosure to a health plan for purposes of carrying out payment or health care operation; and the protected health information pertains solely to a health care item or service which has been paid out of pocket in full. If Avalon or your health plan does agree, Avalon will comply with your request unless the PHI is needed to provide you emergency treatment. In your request, you must provide: (i) the information you are requesting to restrict or limit; (ii) whether you want to limit Avalon use, disclosure, or both; and (iii) to whom you want the limits to apply. You may not limit the uses and disclosures that Avalon or your health plan is legally required or allowed to make.
Right to Request Confidential Communications.
You have the right to request that Avalon communicate with you about medical matters in a certain way or at a certain location. Avalon will notify your health plan of the request received. For example, you can ask that Avalon only contact you at work or by mail. Avalon will not ask you the reason for your request. Avalon will accommodate all reasonable requests as may be determined by your health plan. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to ask Avalon to give you a copy of this Notice at any time by contacting Avalon’s Privacy Officer. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice upon request. You may also obtain a copy of this Notice at the Avalon website, https://www.avalonhcs.com/
TO SUBMIT COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint by contacting Avalon’s Privacy Officer. You may also contact the Secretary of the U.S. Department of Health and Human Services. All complaints to Avalon must be submitted in writing. You will not be retaliated against for filing a complaint.
Privacy Officer
Avalon Health Care Solutions
3405 W. Dr. Martin Luther King Jr. Blvd
Suite 200
Tampa, FL 33607
You may also file a complaint through Avalon’s Compliance Hotline vendor, EthicsPoint, by visiting avalonhcs.ethicspoint.com or calling toll free (855)751-5048.
TO SUBMIT QUESTIONS:
Please direct any questions regarding this notice in writing to Avalon’s Privacy Officer.
Privacy Officer
Avalon Health Care Solutions
3405 W. Dr. Martin Luther King Jr. Blvd
Suite 200
Tampa, FL 33607
Confidential and Proprietary Information of Avalon Health Services, LLC, d/b/a Avalon Healthcare Solutions. © 2021. All rights reserved.
Compliance and Integrity
Avalon implemented a comprehensive compliance program that is integrated throughout the organization. Avalon’s General Counsel, is the Chief Compliance Officer, and is supported by Avalon’s Board of Directors, Compliance Committee, Privacy Officer, and Security Officer. Avalon is committed to a culture of compliance and supports its employees, vendors, contractors, clients, providers, and customers in reporting suspected violations of compliance, fraud, waste, and abuse, or complaints about Avalon’s Privacy and Security policies without fear of retaliation.
Reporting Health Care Fraud, Waste, and Abuse
Health care fraud affects all of us in many ways. The National Heath Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation’s $2.26 trillion in health care spending. If you have a concern, you may make a report, anonymously if preferred, by calling toll free 1-855-751-5048, or visiting www.avalonhcs.ethicspoint.com
You may also write us:
Avalon Compliance Department
3405 W Dr. Martin Luther King Jr. Blvd.,
Suite 200
Tampa, FL 33607
Privacy and Security
Avalon is a technology-enabled laboratory benefit manager that utilizes state-of-the-art technology to protect the privacy and security of its data. Any concerns or complaints regarding Avalon’s privacy or security policies may be directed to Avalon’s Privacy or Security Officer by calling toll free 1-855-751-5048, or visiting www.avalonhcs.ethicspoint.com
Requests for access, amendments, or restrictions to PHI, or an accounting of disclosures must be made in writing to:
Privacy Officer
3405 W Dr. Martin Luther King Jr. Blvd.,
Suite 200
Tampa, FL 33607