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Privacy Information & Member Rights

Privacy Information

Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.

  • Your “personal health information” includes the personal information you gave us when you enrolled in this plan as well as your medical records and other medical and health information.
  • The laws that protect your privacy give you rights related to getting information and controlling how your health information is used.

How do we protect the privacy of your health information?

  • We make sure that unauthorized people don’t see or change your records.
  • In most situations, if we give your health information to anyone who isn’t providing your care or paying for your care, we are required to get written permission from you first. Written permission can be given by you or by someone you have given legal power to make decisions for you.
  • There are certain exceptions that do not require us to get your written permission first. These exceptions are allowed or required by law.
    • For example, we are required to release health information to government agencies that are checking on quality of care.
    • Because you are a member of our plan through Medicare, we are required to give Medicare your health information including information about your Part D prescription drugs. If Medicare releases your information for research or other uses, this will be done according to Federal statutes and regulations.

You can see the information in your records and know how it has been shared with others.

You have the right to look at your medical records held at the plan, and to get a copy of your records. You also have the right to ask us to make additions or corrections to your medical records. If you ask us to do this, we will consider your request and decide whether the changes should be made. You have the right to know how your health information has been shared with others for any purposes that are not routine.

Notice of Privacy Practices for Protected Health Information -  CLICK HERE

Member Rights

Successful relationships take a strong commitment from all sides, with each side recognizing the rights and responsibilities of the other. Your health care is no different. It takes a strong team to work between: you, your health care professionals, and Piedmont for coverage you can count on. Below is a statement of rights and responsibilities that guides Piedmont’s relationship with you. Please read through them, and should you have any questions, please give Piedmont a call.

Piedmont is committed to:

  • Recognizing and respecting you as a plan participant.
  • Encouraging your open discussions with your health care professionals/providers.
  • Providing information to help you become an informed health care consumer.
  • Providing access to health benefits and our network providers.
  • Sharing our expectations of you as a plan participant.

You have the right to:

  • Participate with your health care professionals/providers in making decisions about your health care.
  • Receive the benefits for which you have coverage.
  • Be treated with respect and dignity.
  • Preserve the privacy of your personal health information, consistent with state and federal laws, and our policies.
  • Receive information about our organization and services, our network of health care professionals/providers, and your rights and responsibilities.
  • Candidly discuss with your physicians and providers appropriate and medically necessary care for your condition, regardless of cost or benefit coverage.
  • Make recommendations regarding the rights and responsibilities of plan participants as set forth under your coverage.
  • Voice complaints or appeals about: our organization, any benefit or coverage decisions we (or our designated administrators) make, your coverage, or care provided.
  • Refuse treatment for any condition, illness or disease without jeopardizing future treatment, and be informed by your physician(s) of the medical consequences.
  • Participate in matters of the organization’s policy and operations.

For assistance at any time, contact your local insurance department: by phone in Richmond (804) 371-9032, toll-free from outside Richmond (877) 310-6560, or in writing: Virginia Bureau of Insurance, 1300 East Main Street, P.O. Box 1157, Richmond, VA 23218.

You have the responsibility to:

  • Choose a Primary Care Physician for services, if required under your plan. 
  • Treat all health care professionals and staff with courtesy and respect.
  • Keep scheduled appointments with your doctor, and call the doctor’s office if you have a delay or cancellation.
  • Read and understand to the best of your ability all materials concerning your health benefits or ask for help if you need it.
  • Understand your health problems and participate, along with your health care professionals/providers, in developing mutually agreed upon treatment goals to the degree possible.
  • Supply, to the extent possible, information that Piedmont and/or your health care professionals/providers need to provide care. 
  • Follow the plans and instructions for care that you have agreed on with your health care professional/provider.
  • Tell your health care professional/provider if you do not understand your treatment plan or what is expected of you.
  • Follow all health benefit plan guidelines, provisions, policies and procedures.
  • Let Piedmont know if you have any changes to your: name; address; or family members covered under your coverage.
  • Provide Piedmont with accurate and complete information needed to administer your health benefit plan, including other health benefit coverage and other insurance benefits you may have in addition to your coverage with us.

Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

H1659_Web2018 Approved 10112017
Last update 10/16/2017