What Are Your Rights?

The following are your rights with regards to your health records. If you would like to exercise any of the following rights, please contact us. We can be reached at 1-866-895-1786.

• You have the right to ask us to give your records only to certain people or groups and to say for what reasons. You also have the right to ask us to stop your records from being given to family members or others who are involved in your healthcare. Please note that while we will try to follow your wishes, the law does not make us do so.
• You have the right to ask to get confidential communications of your health records. For example, if you believe that you would be harmed if we send your records to your current mailing address, you can ask us to send your health records by other means. Other means might be fax or an alternate address.
• You have a right to request mental health records. This information can only be provided with the approval of the treating provider responsible for the condition to which the information relates, or another equally qualified mental health professional. Upon release of any medical or mental health record information to a medical professional designated by you, CeltiCare will notify you that the information was provided to the medical professional.
• You have the right to view and get a copy of all the records we keep about you in your designated record set. This consists of anything we use to make decisions about your health. It includes enrollment, payment, claims processing and medical management records.

You do not have the right to get certain types health records. We may decide not to give you the following:

• Information contained in psychotherapy notes.
• Information collected in reasonable anticipation of, or for use in a court case or another legal proceeding.
• Information subject to certain federal laws about biological products and clinical laboratories.
• In certain situations, we may not let you get a copy of your health records. You will be informed in writing. You may have the right to have our action reviewed.
• You have the right to ask us to make changes to wrong or incomplete health records we keep about you. These changes are known as amendments. Any request for an amendment must be in writing. You need to give a reason for your change(s). We will get back to you in writing no later than 30 days after we receive your request. If your health information is not maintained on-site, we will respond no later than 60 days after we receive your request. If we need additional time, we may take up to another 30 days. We will inform you of any delays and the date when we will get back to you.
• If we make your changes, we will let you know they were made. We will also give your changes to others who we know have your health records and to other persons you name. If we choose not to make your changes, we will let you know why in writing. You will have a right to submit a letter disagreeing with us. We have a right to answer your letter. You then have the right to ask that your original request for changes, our denial and your second letter disagreeing with us be put with your health records for future disclosures
• You have the right to receive an accounting of disclosures of your health records to others for six years beginning on the first day or enrollment with CeltiCare. By law, we do not have to give you a list of the following:
• Health records given or used for treatment, payment and healthcare operations purposes.
• Health records given to you or others with your written approval.
• Information that is incidental to a use or disclosure otherwise permitted.
• Health records given to persons involved in your care or for other notification purposes.
• Health records used for national security or intelligence purposes.
• Health records given to prisons, police, FBI and others who enforce laws or health oversight agencies.
• Health records given or used as part of a limited data set for research, public health or healthcare operations purposes.

To receive an accounting of disclosures, your request must be in writing.  We will act on your request within 60 days.  If we need more time, we may take up to another 30 days. Your first list will be free. We will give you one free list every 12 months.  If you ask for another list within 12 months, we may charge you a fee.  We will tell you the fee in advance and give you a chance to take back your request.

Using Your Rights

• You have a right to receive a copy of this notice at any time. We reserve the right to change the terms of this notice.  Any changes in our privacy practices will apply to all the health records that we keep. If we make changes, we will send a new notice to you.
• If you have any questions about this notice or how we use or share your health records, please call.  We can be reached at 1-866-895-1786, Monday through Friday from 8:00 a.m. to 5:00 p.m.

If you believe your privacy rights have been violated, you may write a letter of
complaint to:

Privacy Official

CeltiCare Health Plan of Massachusetts, Inc.

1380 Soldiers Field Road, Suite 300

Brighton, Massachusetts 02135

Phone: 1-866-895-1786
Fax: 1-888-828-5698

You may also contact the Secretary of the United States Department of Health and Human Services:

Office for Civil Rights – Region I
U.S. Department of Health & Human Services
Government Center
J.F. Kennedy Federal Building – Room 1875
Boston, MA 02203
Voice phone(617)565-1340
FAX (617)565-3809
TDD (617)565-1343

WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT