Aetna may use and disclose your information in various ways
In administering your health benefits, Aetna says it may use and disclose your personal information in various ways, 'including' health care operations, payment, treatment and disclosures to other covered entities (the cards that follow). These are permissions, not duties. They are qualified elsewhere in the notice. Aetna may also disclose health information to a relative, friend or other person you identify, but only information directly relevant to that person's involvement with your care or payment for it, and you can stop or limit that by calling the toll-free hotline. Information that comes from a substance use disorder program with a 42 CFR Part 2 consent is used or shared in accordance with both that consent and HIPAA. Some state and federal laws may add special protections for certain sensitive health information (see the section on additional restrictions).
Supporting quotations
In administering your health benefits, we may use and disclose this information in various ways, including:
We may disclose health information about you to a relative, a friend, or any other person you identify, provided the information is directly relevant to that person’s involvement with your health care or payment for that care.
You have the right to stop or limit this kind of disclosure by calling our toll-free hotline at 1-800-537-8521.
Some state and federal laws may require special privacy protections, including certain requirements to obtain attestations from requestors, that limit the use and disclosure of certain sensitive health information.
If a substance use disorder program provides us this information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment, and health care operations, we will use or share that information in accordance with both the consent and HIPAA.
Disclosure to Others Involved in Your Health Care
Additional Restrictions on Use and Disclosure
Substance Use Disorder Information
Qualifications & exceptions
'May' and 'including' make the list permissive and non-exhaustive here; the notice has further sections on additional reasons for disclosure, required disclosures and disclosures needing your written authorization.
Disclosure to people involved in your care is limited to information directly relevant to that person's involvement.
You have the right to stop or limit disclosures to people involved in your care.
Some state and federal laws may add special protections for certain sensitive health information, as described in the additional-restrictions section.
Not stated here
The notice does not say which state laws apply or how requestor attestations work in practice.
Use & Processing · Permission or license
Use and disclosure for Aetna's health care operations
Aetna may use and disclose personal information while running its health business: quality assessment and improvement, performance measurement and outcomes assessment, health services research, and disease management, case management and care coordination. For example, it may use information to run disease management programs for members with specific conditions such as diabetes, asthma or heart failure. Other operational activities that need use and disclosure include administering reinsurance and stop loss, underwriting and rating, detecting and investigating fraud, transferring policies or contracts to or from other health plans, and other general administrative activities such as data and information systems management and customer service.
Supporting quotations
Health Care Operations: We may use and disclose personal information during the course of running our health business – that is, during operational activities such as quality assessment and improvement; performance measurement and outcomes assessment; health services research; and disease management, case management and care coordination.
For example, we may use the information to provide disease management programs for members with specific conditions, such as diabetes, asthma, or heart failure.
Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; underwriting and rating; detection and investigation of fraud; transfer of policies or contracts from and to other health plans;
Qualifications & exceptions
'May' makes this a permission, not a duty.
'Other operational activities' and 'other general administrative activities' leave the list open.
Underwriting is listed as an operations use; the notice separately gives you the right to know the reasons for an unfavorable underwriting decision (see Your Legal Rights).
Not stated here
The notice does not say how much information is used for each purpose or which parties receive it for research.
Use & Processing · Permission or license
Use and disclosure to pay for covered services
To help pay for your covered services, Aetna may use and disclose personal information in conducting utilization and medical necessity reviews, coordinating care, determining eligibility, collecting premiums, and responding to complaints, appeals and requests for external review. For example, it may use your medical history and other health information to decide whether you have suffered a loss of functional capacity, and may disclose information to your provider during that process.
Supporting quotations
Payment: To help pay for your covered services, we may use and disclose personal information in a number of ways – in conducting utilization and medical necessity reviews; coordinating care; determining eligibility; collecting premiums; and responding to complaints, appeals and requests for external review.
For example, we may use your medical history and other health information about you to determine if you have suffered a loss of functional capacity – and during the process, we may disclose information to your provider.
Qualifications & exceptions
'May' makes this a permission; 'in a number of ways' means the listed purposes are examples.
Not stated here
The notice does not say what 'loss of functional capacity' means for a particular plan.
Use & Processing · Permission or license
Use for treatment alternatives, reminders and health-related benefits
Aetna may use or disclose personal information about you to provide treatment alternatives, treatment reminders, or other health-related benefits and services.
Supporting quotations
We may use or disclose personal information about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services.
Qualifications & exceptions
'May' makes this a permission.
'Other health-related benefits and services' is open-ended.
Marketing that is unrelated to your benefit plan(s) is treated differently: the notice says Aetna will ask for your written authorization for it.
Not stated here
The notice does not say how Aetna decides which services count as health-related benefits rather than marketing.
Use & Processing · Company commitment
Written authorization for uses not described in the notice
For all situations other than those described above in the notice (health care operations, payment, treatment, disclosures to other covered entities, additional reasons for disclosure, required disclosures and disclosures to people involved in your care), Aetna says it will ask for your written authorization before using or disclosing personal information about you. Examples where it will get authorization: marketing purposes unrelated to your benefit plan(s), before disclosing any psychotherapy notes, the sale of your health information, and other reasons required by law.
Supporting quotations
In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you.
for marketing purposes that are unrelated to your benefit plan(s),
before disclosing any psychotherapy notes,
related to the sale of your health information, and
for other reasons as required by law.
How Aetna Uses and Discloses Personal Information
Health Care Operations:
Payment:
Treatment:
Disclosures to Other Covered Entities:
Qualifications & exceptions
The authorization rule applies only to situations 'other than those described above'; the described uses and disclosures do not require it.
The examples are introduced by 'for example', so the list is not exhaustive.
Marketing is listed only when unrelated to your benefit plan(s).
Not stated here
The notice does not say whether marketing related to your benefit plan(s) needs authorization.
Cross-references
qualifies (model-proposed): Aetna may use and disclose your information in various ways — qualifies: Written authorization is required for situations other than those the notice describes, which bounds the general permissions to use and disclose information.
Use & Processing · User right or choice
You can revoke an authorization in writing
If you have given Aetna an authorization, you may revoke it in writing at any time, if Aetna has not already acted on it. For questions about authorizations you can call the toll-free hotline, 1-800-537-8521.
Supporting quotations
If you have given us an authorization, you may revoke it in writing at any time, if we have not already acted on it.
If you have questions regarding authorizations, please call our toll-free hotline at 1-800-537-8521.
Qualifications & exceptions
Revocation must be in writing.
Revocation does not undo action Aetna has already taken on the authorization.
Not stated here
The notice does not give a mailing address specifically for revocations; the address shown later is for complaints.
Use & Processing · Restriction or exception
How information from substance use disorder programs is handled
Aetna says it is not a substance use disorder treatment program, but it may receive or keep information about you that comes from one. If such a program gives Aetna this information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment and health care operations, Aetna will use or share it in accordance with both the consent and HIPAA. In limited situations where Aetna may disclose it without your permission, such as medical emergencies and government audits, Aetna says it will follow the law that is more protective of your information.
Supporting quotations
We are not a substance use disorder treatment program. We may receive or keep information about you that comes from a substance use disorder program.
If a substance use disorder program provides us this information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment, and health care operations, we will use or share that information in accordance with both the consent and HIPAA.
In limited situations where we may disclose this information without your permission, such as medical emergencies and government audits, we will follow the law that is more protective of your information.
Qualifications & exceptions
The rule covers information received through a 42 CFR Part 2 consent.
The more-protective-law commitment applies to the 'limited situations' where disclosure without permission may occur; medical emergencies and government audits are examples.
Not stated here
The notice does not say what the Part 2 consent covers beyond treatment, payment and health care operations, or how Aetna handles substance use disorder information that does not come through a Part 2 consent.
Cross-references
qualifies (model-proposed): Aetna may use and disclose your information in various ways — qualifies: Information from substance use disorder programs received under a Part 2 consent is used or shared in accordance with both the consent and HIPAA, which qualifies the general treatment, payment and operations permissions.
Use & Processing · User right or choice
Right to ask Aetna to restrict uses and disclosures
You have the right to ask Aetna to restrict how it uses or discloses health information about you in connection with health care operations, payment and treatment (the uses described earlier in the notice, including disclosures to other covered entities). Aetna says it will consider such requests but may not agree to them. You also have the right to ask Aetna to restrict disclosures to persons involved in your health care.
Supporting quotations
You have the right to ask us to restrict the way we use or disclose health information about you in connection with health care operations, payment and treatment.
We will consider, but may not agree to, such requests.
You also have the right to ask us to restrict disclosures to persons involved in your health care.
How Aetna Uses and Discloses Personal Information
Payment:
Disclosures to Other Covered Entities:
Disclosure to Others Involved in Your Health Care
You have the right to stop or limit this kind of disclosure by calling our toll-free hotline at 1-800-537-8521.
Qualifications & exceptions
Aetna will consider but may not agree to restriction requests.
The earlier section on others involved in your care says you have the right to stop or limit those disclosures by calling the hotline.
Not stated here
This rights section words the right for people involved in your care as a right to ask; the earlier section words it as a right to stop or limit. The notice does not say whether Aetna can refuse a request for that kind of disclosure.
Cross-references
contrast (model-proposed): Disclosure to a relative, friend or caregiver — contrast: This rights section words the right for disclosures to people involved in your care as a right to ask for a restriction that Aetna may not agree to, while the earlier section says you have the right to stop or limit that kind of disclosure by calling the hotline. The notice does not reconcile the two wordings.
Use & Processing · User right or choice
Right to know reasons for an unfavorable underwriting decision
You have the right to know the reasons for an unfavorable underwriting decision. Previous unfavorable underwriting decisions may not be used as the basis for future underwriting decisions unless Aetna makes an independent evaluation of the basic facts. Underwriting is also listed earlier as a health care operation for which information may be used.
Supporting quotations
You have the right to know the reasons for an unfavorable underwriting decision.
Previous unfavorable underwriting decisions may not be used as the basis for future underwriting decisions unless we make an independent evaluation of the basic facts.
Qualifications & exceptions
A previous unfavorable decision can be a basis for a future one only if Aetna makes an independent evaluation of the basic facts.
Not stated here
The notice does not say how to request the reasons or how long Aetna takes to provide them.
Cross-references
qualifies (model-proposed): Use and disclosure for Aetna's health care operations — qualifies: Underwriting is listed as a health care operation; the rights section gives members the right to know the reasons for an unfavorable underwriting decision and limits reliance on earlier unfavorable decisions.