Privacy Policy

This Notice becomes effective on April 14, 2003.

 We are required by law to maintain the privacy of your protected health information. We are obligated to provide you with a copy of this Notice of our legal duties and our privacy practices with respect to protected health information and we must abide by the terms of this notice. We reserve the right to change the provisions of our Notice and make the new provisions effective for all protected health information that we maintain. If we make a material change to our Notice, we will mail a revised Notice to the address that we have on record for you.

 The following is a description of how we are most likely to use and/or disclose your protected health information. Where state law provides additional restrictions on how we can use and disclose information, we will follow applicable state laws.

 You may complain to us if you believe that we have violated your privacy rights. You may file a complaint with us in writing to: American Diabetic Supply, Inc., HIPPA Compliance, 400 S. Atlantic Avenue, Suite 108, Ormond Beach, FL 32141.

 You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. Complaints filed directly with the Secretary must:

 1) be in writing 2) contain the name of the entity against which the complaint is lodged 3) describe the relevant problems and 4) be filed within 180 days of the time you became aware of the problem.

 We will not penalize or in any way retaliate against you for filing a complaint with the Secretary or us.

 Payment and Health Care Operations

 We have the right to use and disclose your protected health information for all activities that are included within the definitions of “payment” and “health care operations” as set out in 45 C.F.R. section 164.501 (this provision is a part of what is known as “the HIPPA Privacy Regulations). We have not listed in this Notice all of the activities included within these definitions, so please refer to 45 C.F.R. section 164.501 for a complete list.

 Payment

 We will use or disclose your protected information to fulfill our responsibilities for coverage and providing benefits under your policy. For example, we may disclose your protected health information when a provider requests information regarding your eligibility for coverage under our health plan, or we may use your information to determine if a treatment that you received was medically necessary.

 Health Care Operations

 We will use or disclose your protected health information to support our business functions. These functions include, but are not limited to: quality assessment and improvement, reviewing provider performance, licensing, business planning and business development. For example, we may use your information (i) to respond to a customer service inquiry from you (ii) to review the quality of medical services being provided to you, or (iii) to conduct audits or medical review of claims activity.

 Business Associates

 We contract with individuals and entities (known as “business associates”) to perform various functions on our behalf or to provide certain types of services. Some of the functions they provide are administering claims and policy service support. To perform these functions or to provide the services, business associates will receive, create, maintain, use or disclose protected health information, but only after we require the business associates to agree in writing to contract terms designed to appropriately safeguard your information.

 Other Possible Uses and Disclosures of Protected Health Information

 We may disclose your protected health information in other ways, which law permits us to. Those ways may include health oversight activities; as required by law; in connection with public health activities; abuse or neglect reports required by governmental authorities; legal proceedings; law enforcement; coroners, medical examiners, funeral directors, and organ donations; research; military activity and national security; in connection with an inmate of a correctional institution; worker’s compensation; or to others involved in your health care.

 Required Disclosures of your Protected Health Information

 The following is a description of disclosures that we are required by law to make.

Disclosures to the Secretary of the U. S. Department of Health and Human Services

 We are required to disclose your protected health information to the Secretary if the U. S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPPA Privacy Regulations.

Disclosures to You

 We are required to disclose to you most of your protected health information in a “designated record set” when you request access to this information. Generally, a “designated record set” contains medical and billing records, as well as other records that are used to make decisions about your health care benefits. We also are required to provide, upon request, an accounting of many disclosures of your protected health information that are for reasons other than payment and health care operations.

 Other Uses and Disclosures of Your Protected Health Information

 Other uses and disclosures of your protected health information that are not described above will be made only with your written authorization. If you provide us with such an authorization, you may revoke the authorization in writing, and this revocation will be effective for future uses and disclosures of protected health information. However, the revocation will not be effective for the information that we already have used or disclosed in reliance

 on your authorization.

 Your Rights

 You have the right to request a restriction on the protected health information we use or disclose bout you for payment or health care operations.

 We are not required to agree to any restriction that you may request. If we do agree to the restriction, we will comply with the restriction unless the information is needed to provide service to you under the policy.

 You may request a restriction in writing. In your request tell us (1) the information whose disclosure you want to limit and (2) how you want to limit our use and/or disclosure of the information.

 Right to Request Confidential Communications

 If you believe that a disclosure of all or part of your protected health information may endanger you, you may request in writing that we communicate only with you regarding your information in an alternative manner or at an alternative location.

 In your request tell us (1) the parts of your protected health information that you want us to communicate with you in an alternative manner or at an alternative location and (2) that the disclosure of all or part of the information in a manner inconsistent with your instructions would put you in danger.

 Right to Inspect and Copy

 You have the right to inspect and copy your protected health information that is contained in a “designated record set.” Generally, a “designated records set” contains medical and billing records, as well as other records that are used to make decisions about your health care benefits. However, you may not inspect or copy psychotherapy notes or certain other information that may be contained in a designated record set.

 To inspect and copy your protected health information that is contained in a designated record set, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

 We may deny your request to inspect and copy your protected health information in certain limited circumstances. If you are denied access to your information, and you request that the denial be reviewed, we will review your request.

 Right to Amend

 If you believe that your protected health information is incorrect or incomplete, you may request in writing that we amend your information. Your request should include the reason the amendment is necessary.

 In certain cases, we may deny your request for an amendment. For example, we may deny your request if the information you want to amend is not maintained by us, but by another entity. If we deny your request, you may have the right to file a statement of disagreement with us. Your statement of disagreement will be linked with the disputed information and all future disclosures of the disputed information will include your statement.

 Right of Accounting

 You have a right to request in writing an accounting of most disclosures of your protected health information that are for reasons other than payment or servicing your policy. An accounting will include the date(s) of the disclosure to whom we made the disclosure, a brief description of the information disclosed, and the purpose for the disclosure.

 You request may be for disclosures made up to 6 years before the date of your request, but in no event, for disclosures made before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw your request at the time before any costs are incurred.