A member's state may give additional rights to limit sharing
Anthem says a member's state may give additional rights to limit the sharing of health information. For details, the member should call the Member Services phone number on the health plan ID card.
Supporting quotations
Your state may give you additional rights to limit sharing your health information.
Please call the Member Services phone number on your health plan ID card for more details.
Qualifications & exceptions
Whether any additional right exists depends on the member's state; the notice states only that it may.
Not stated here
The paragraph lists no state right; it only directs the member to call Member Services.
Sharing & Disclosure · Company practice
Anthem may share PI outside the company, in some cases without approval
Anthem says it may share a member's PI with others outside the company, in some cases without the member's approval, while taking reasonable measures to protect the information.
Supporting quotations
We may also share your PI with others outside our company — without your approval, in some cases.
But we take reasonable measures to protect your information.
Qualifications & exceptions
'In some cases' limits the without-approval sharing to unspecified cases.
The protective measures are described only as 'reasonable'.
Not stated here
This paragraph does not name the recipients or the cases in which approval is not needed.
Sharing & Disclosure · User right or choice
Where an activity requires an opt-out chance, Anthem says it will tell members how
If an activity requires Anthem to give a member a chance to opt out, Anthem says it will let the member know, and will explain how to tell it that the member does not want PI used or shared for an activity the member can opt out of.
Supporting quotations
If an activity requires us to give you a chance to opt out, we’ll let you know, and we’ll let you know how to tell us you don’t want your PI used or shared for an activity you can opt out of.
Qualifications & exceptions
Applies only to an activity that requires an opt-out chance; the notice does not say which activities those are.
Not stated here
This paragraph does not identify which activities carry an opt-out or how to opt out.
Sharing & Disclosure · Company practice
Example: Anthem may give information to a doctor's office to confirm benefits
As an example, Anthem says it may give information to a doctor's office to confirm a member's benefits.
Supporting quotations
We may give information to a doctor’s office to confirm your benefits.
Qualifications & exceptions
'May' makes this a permitted use, not a statement that it always happens.
Sharing & Disclosure · Company practice
Example: Anthem may share a member's explanation of benefits with the plan subscriber
As an example, Anthem says it may share a member's explanation of benefits (EOB) with the subscriber of the plan for payment purposes. The subscriber is the person who holds the plan, who may be a different person from the member whose benefits the EOB describes.
Supporting quotations
We may share your explanation of benefits (EOB) with the subscriber of your plan for payment purposes.
Qualifications & exceptions
Stated purpose is payment.
Not stated here
The notice does not say what an EOB contains or what limits apply when the member and subscriber differ.
Sharing & Disclosure · Company practice
Example: Anthem may share PHI with a doctor or hospital so they can treat the member
As an example, Anthem says it may share PHI with a member's doctor or hospital so that they may treat the member.
Supporting quotations
We may share PHI with your doctor or hospital so that they may treat you.
Sharing & Disclosure · User right or choice
Example: Anthem may share PHI with health information exchanges
As an example, Anthem says it may use and share PHI directly or indirectly with health information exchanges for payment, healthcare operations, and treatment. A member who does not want PHI shared in these situations is directed to anthem.com/privacy for more information.
Supporting quotations
We may also use and share PHI directly or indirectly with health information exchanges for payment, healthcare operations, and treatment.
If you don’t want your PHI to be shared in these situations, visit anthem.com/privacy for more information.
Qualifications & exceptions
Purposes are limited to payment, healthcare operations and treatment.
Not stated here
The anthem.com/privacy page is not part of the supplied source, so how to stop this sharing is not stated here.
Sharing & Disclosure · User right or choice
Emails may carry limited PHI and Anthem says it will ask permission before contacting
Anthem says a member may get emails that have limited PHI, such as welcome materials, and that it will ask the member's permission before it contacts them.
Supporting quotations
You may get emails that have limited PHI, such as welcome materials.
We’ll ask your permission before we contact you.
Qualifications & exceptions
'Limited PHI, such as welcome materials' limits the emails the sentence describes.
Not stated here
The notice does not say whether the permission commitment covers only the emails or all the contacts described earlier in the paragraph.
Cross-references
contrast (model-proposed): A member who does not want phone contact can tell the caller or call 844-203-3796 — contrast: One passage says Anthem will ask permission before it contacts the member, while another describes phone and text contact that Anthem may make using an autodialer, which the member stops by telling the caller or calling the Do Not Call number. The notice does not say whether the permission sentence covers phone and text contact.
Sharing & Disclosure · Restriction or exception
Outside treatment, payment, operations or research, Anthem generally needs written permission
Anthem says that in most cases, if it uses or shares PHI outside of treatment, payment, operations or research activities, it has to get the member's okay in writing first.
Supporting quotations
Sharing your PHI with others: In most cases, if we use or share your PHI outside of treatment, payment, operations, or research activities, we have to get your okay in writing first.
Qualifications & exceptions
'In most cases' means there are exceptions; the notice lists several in the sections that follow (for example uses for the public good, and best-interest sharing in an emergency).
Sharing & Disclosure · Restriction or exception
Written permission is required before certain marketing, selling PHI or sharing psychotherapy notes
Anthem says it must also get the member's written permission before using PHI for certain marketing activities, selling PHI, or sharing any psychotherapy notes from the member's doctor or therapist.
Supporting quotations
We must also get your written permission before:
Using your PHI for certain marketing activities.
Selling your PHI.
Sharing any psychotherapy notes from your doctor or therapist
Qualifications & exceptions
Only 'certain' marketing activities are named; the notice does not say which.
Not stated here
The notice does not say which marketing activities need written permission.
Sharing & Disclosure · User right or choice
Other situations may need written permission, and a member can cancel written permission at any time
Anthem says it may also need written permission for other situations not mentioned in the list. The member always has the right to cancel any written permission given, at any time.
Supporting quotations
We may also need your written permission for other situations not mentioned above.
You always have the right to cancel any written permission you give at any time.
Qualifications & exceptions
'May also need' is not a list of those situations.
Not stated here
This paragraph does not say how to cancel; the later Authorization paragraph says cancellation is in writing and not retroactive.
Sharing & Disclosure · User right or choice
Members can tell Anthem to share information with family, friends or others involved in care or payment
Anthem says the member has the right and choice to tell it to share information with family, close friends, or others involved with the member's current treatment or payment for care.
Supporting quotations
You have the right and choice to tell us to:
Share information with your family, close friends, or others involved with your current treatment or payment for your care.
Not stated here
The source does not say how a member tells Anthem this.
Sharing & Disclosure · User right or choice
Members can tell Anthem to share information in an emergency or disaster relief situation
Anthem says the member has the right and choice to tell it to share information in an emergency or disaster relief situation.
Supporting quotations
You have the right and choice to tell us to:
Share information in an emergency or disaster relief situation.
Not stated here
The source does not say how a member tells Anthem this.
Sharing & Disclosure · Permission or license
If a member can't state a preference, Anthem may share PHI it believes is in their best interest
If a member can't tell Anthem their preference, for example in an emergency or if unconscious, Anthem says it may share PHI if it believes this is in the member's best interest. It may also share information when needed to lessen a serious and likely threat to the member's health or safety.
Supporting quotations
If you can’t tell us your preference, for example in an emergency or if you’re unconscious, we may share your PHI if we believe it’s in your best interest.
We may also share your information when needed to lessen a serious and likely threat to your health or safety.
Qualifications & exceptions
The best-interest sharing depends on Anthem's own belief; the threat sharing requires a threat that is both serious and likely.
Cross-references
qualifies (model-proposed): Members can tell Anthem to share information in an emergency or disaster relief situation — qualifies: When the member cannot state a preference, for example in an emergency, Anthem says it may share PHI it believes is in the member's best interest, which qualifies the member's choice to tell Anthem what to share in an emergency.
Sharing & Disclosure · Permission or license
Anthem is allowed, and sometimes required, to share information for specific public-good purposes
Anthem says it is allowed, and in some cases required, to share a member's information in other ways, usually for the good of the public, such as public health and research, for the specific purposes listed. The list covers public health and safety issues, research, obeying the law, organ donation groups, workers' compensation, law enforcement and other government requests, lawsuits, and responses to the Secretary of Health and Human Services.
Supporting quotations
Other reasons we may use or share your information:
We are allowed, and in some cases required, to share your information in other ways
We can share your information for these specific purposes:
Qualifications & exceptions
The notice says 'usually' for the good of the public, so not every listed purpose is public-good in kind.
Sharing & Disclosure · Permission or license
Information may be shared to help with public health and safety issues
Among the specific purposes, Anthem lists helping with public health and safety issues, such as preventing disease, helping with product recalls, reporting adverse reactions to medicines, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
Supporting quotations
Helping with public health and safety issues, such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medicines
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
Qualifications & exceptions
'Such as' makes the five examples illustrative.
Not stated here
The notice does not say who receives the information in these cases.
Sharing & Disclosure · Permission or license
Information may be shared for health research
Among the specific purposes, Anthem lists doing health research. The earlier written-permission rule treats research as outside the cases where Anthem generally needs a written okay, and this item does not describe any research-specific conditions.
Supporting quotations
Doing health research.
Not stated here
The notice does not describe conditions, safeguards or recipients for research use.
Sharing & Disclosure · Permission or license
Information may be shared if the law requires it
Among the specific purposes, Anthem lists obeying the law, if it requires sharing the member's information.
Supporting quotations
Obeying the law, if it requires sharing your information.
Qualifications & exceptions
Applies when a law requires the sharing.
Sharing & Disclosure · Permission or license
Information may be shared with organ donation groups
Among the specific purposes, Anthem lists responding to organ donation groups for research and other reasons.
Supporting quotations
Responding to organ donation groups for research and other reasons.
Qualifications & exceptions
'Other reasons' is not specified.
Sharing & Disclosure · Permission or license
Information may be shared for workers' compensation, law enforcement and other government requests
Among the specific purposes, Anthem lists addressing workers' compensation, law enforcement and other government requests, and alerting proper authorities if it believes the member may be a victim of abuse or other crimes.
Supporting quotations
Addressing workers’ compensation, law enforcement, and other government requests, and to alert proper authorities if we believe you may be a victim of abuse or other crimes.
Qualifications & exceptions
The alert to authorities depends on Anthem's belief that the member may be a victim.
Not stated here
The notice does not say what conditions a law enforcement or government request must meet.
Sharing & Disclosure · Permission or license
Information may be shared in responding to lawsuits and legal actions
Among the specific purposes, Anthem lists responding to lawsuits and legal actions.
Supporting quotations
Responding to lawsuits and legal actions.
Not stated here
The notice does not say what limits apply to sharing in legal proceedings.
Sharing & Disclosure · Permission or license
Information may be shared with the Secretary of Health and Human Services for HIPAA compliance
Among the specific purposes, Anthem lists responding to the Secretary of Health and Human Services for HIPAA rules compliance and enforcement purposes.
Supporting quotations
Responding to the Secretary of Health and Human Services for HIPAA rules compliance and enforcement purposes.
Sharing & Disclosure · Permission or license
Employer-based members: PHI may be shared with the group health plan; an employer may get PHI only for permitted reasons
For members enrolled through an employer, Anthem says it may share PHI with the member's group health plan. If the employer pays the premium or part of it but does not pay health insurance claims, the employer can only have the member's PHI for permitted reasons and is required by law to protect it.
Supporting quotations
If you’re enrolled with us through an employer, we may share your PHI with your group health plan.
If the employer pays your premium or part of it, but doesn’t pay your health insurance claims, your employer can only have your PHI for permitted reasons and is required by law to protect it.
Qualifications & exceptions
Applies to members enrolled through an employer.
The 'permitted reasons' limit applies to an employer that pays premium but not claims.
Not stated here
The notice does not say what the permitted reasons are or what happens when an employer pays claims.
Sharing & Disclosure · User right or choice
Anthem gets written permission for any purpose not stated; permission can be cancelled in writing but not undone
Anthem says it will get the member's written permission before using or sharing PHI for any purpose not stated in the notice. The member may cancel permission at any time, in writing, and Anthem will then stop using PHI for that purpose. If Anthem has already used or shared PHI with permission, it cannot undo actions taken before the member told it to stop.
Supporting quotations
Authorization: We’ll get your written permission before we use or share your PHI for any purpose not stated in this notice.
You may cancel your permission at any time, in writing.
We will then stop using your PHI for that purpose.
But if we’ve already used or shared your PHI with your permission, we cannot undo any actions we took before you told us to stop.
Qualifications & exceptions
Cancellation must be in writing and is not retroactive.
Members who pay in full out of pocket can ask for a restriction; Anthem may not agree in some cases
If the member pays in full for any medical services out of pocket, the member has the right to ask for a restriction that would prevent the use or sharing of that PHI for treatment, payment, or operations reasons. If the member or the care provider submits a claim to Anthem, Anthem may not agree to a restriction. If a law requires sharing the information, Anthem does not have to agree to the restriction.
Supporting quotations
Ask for a restriction for services you pay for out of your own pocket:
If you pay in full for any medical services out of your own pocket, you have the right to ask for a restriction.
The restriction would prevent the use or sharing of that PHI for treatment, payment, or operations reasons.
If you or your care provider submits a claim to us, we may not agree to a restriction
If a law requires sharing your information, we don’t have to agree to your restriction.
Qualifications & exceptions
Applies when the member pays in full out of pocket.
Does not apply the same way if a claim is submitted to Anthem, or where a law requires sharing.
Not stated here
The notice does not say whether the member must tell the provider not to submit a claim.