Anthem Blue Cross and Blue Shield Privacy Practices

Use & Processing · Permission or license

Anthem may collect, use and share PHI as the law allows or requires

Anthem says there are times it may collect, use and share a member's Protected Health Information (PHI) as allowed or required by law, including the HIPAA Privacy rule, and then lists some of those times: payment, healthcare operations and treatment activities, with examples.

Supporting quotations

Your protected health information

There are times we may collect, use, and share your Protected Health Information (PHI) as allowed or required by law, including the HIPAA Privacy rule.

Here are some of those times:

Qualifications & exceptions

• 'Some of those times' means the list that follows is not stated to be complete.

Cross-references

• qualified by (model-proposed): Substance use disorder information is covered by 42 CFR Part 2 and consent rules — The substance use disorder passage adds that disclosures of that information must also comply with 42 CFR Part 2 and other privacy laws, so the general permission to use and share PHI is limited for that information.

Use & Processing · Company practice

PHI is used and shared to manage accounts and benefits and pay claims

For payment, Anthem says it collects, uses and shares PHI to take care of a member's account and benefits or to pay claims for healthcare the member gets through the plan.

Supporting quotations

Payment: We collect, use, and share PHI to take care of your account and benefits or to pay claims for healthcare you get through your plan.

Use & Processing · Company practice

PHI is used and shared for Anthem's healthcare operations

Anthem says it collects, uses and shares PHI for its healthcare operations. This paragraph does not itself say what those operations include.

Supporting quotations

Healthcare operations: We collect, use, and share PHI for our healthcare operations.

Not stated here

• The source does not define healthcare operations in this paragraph; the examples after it (such as quality review) may illustrate it, but the notice does not say they are the whole of it.

Use & Processing · Company practice

Anthem does not provide treatment but uses and shares treatment information to offer services

Anthem says it does not provide treatment, but it collects, uses and shares information about a member's treatment to offer services that may help the member, including sharing information with others who provide the member treatment.

Supporting quotations

Treatment activities: We don’t provide treatment, but we collect, use, and share information about your treatment to offer services that may help you, including sharing information with others providing you treatment.

Qualifications & exceptions

• Anthem disclaims providing treatment itself.

Use & Processing · Company practice

Example: Anthem may use PHI to review the quality of care and services

As an example, Anthem says it may use PHI to review the quality of care and services a member gets.

Supporting quotations

We may use PHI to review the quality of care and services you get.

Use & Processing · Company practice

Example: Anthem may use PHI to help with services for conditions like asthma, diabetes or traumatic injury

As an example, Anthem says it may use PHI to help a member with services for conditions like asthma, diabetes, or traumatic injury.

Supporting quotations

We may use PHI to help you with services for conditions like asthma, diabetes, or traumatic injury.

Qualifications & exceptions

• 'Conditions like' makes the three conditions illustrative.

Use & Processing · Company practice

Example: Anthem may use PHI with technology to support and enable services

As an example, Anthem says it may use PHI with technology to support and enable services provided to a member.

Supporting quotations

We may use PHI with technology to support and enable services provided to you.

Not stated here

• The source does not say what technology is used.

Use & Processing · Permission or license

Example: Anthem may use PHI to create, use or share de-identified data as HIPAA allows

As an example, Anthem says it may use a member's PHI to create, use, or share de-identified data as allowed by HIPAA.

Supporting quotations

We may use your PHI to create, use, or share de-identified data as allowed by HIPAA.

Qualifications & exceptions

• Limited to what HIPAA allows for de-identified data.

Not stated here

• The source does not say who may receive de-identified data or for what purposes.

Use & Processing · Company practice

Anthem may contact members about treatment options, benefits and other plans

Anthem says it may contact a member about treatment options or other health-related benefits and services. When a member or dependent reaches a certain age, it may tell the member about other plans or programs they may be eligible for, including individual coverage. It may also send reminders about routine medical checkups and tests.

Supporting quotations

We may also contact you about treatment options or other health-related benefits and services.

When you or your dependents reach a certain age, we may tell you about other plans or programs for which you may be eligible, including individual coverage.

We may also send you reminders about routine medical checkups and tests.

Qualifications & exceptions

• Each is 'may', a permitted contact, not a promise to contact.

Not stated here

• The source does not say what age triggers the plan information.

Use & Processing · Restriction or exception

Anthem cannot use genetic information to decide coverage or its price

Anthem says it cannot use a member's genetic information to decide whether it will give coverage or how it determines the price of that coverage.

Supporting quotations

Genetic information: We cannot use your genetic information to decide whether we’ll give you coverage or how we determine the price of that coverage.

Use & Processing · Company practice

Anthem may use this demographic information to identify needs, develop programs and offer interpretation

Anthem says it may use race, ethnicity, language, sexual orientation and gender identity information to help the member, including identifying specific needs, developing programs and educational materials, and offering interpretation services.

Supporting quotations

We may use this information to help you, including identifying your specific needs, developing programs and educational materials, and offering interpretation services.

Qualifications & exceptions

• 'Including' makes the three uses illustrative.

Use & Processing · Restriction or exception

Anthem does not use this demographic information to decide coverage, kind of coverage or price

Anthem says it does not use race, ethnicity, language, sexual orientation and gender identity information to decide whether it will give coverage, what kind of coverage, or the price of that coverage. It says it does not share this information with unauthorized persons.

Supporting quotations

We don’t use race, ethnicity, language, sexual orientation, and gender identity information to decide whether we’ll give you coverage, what kind of coverage and the price of that coverage.

We don’t share this information with unauthorized persons.

Not stated here

• The notice does not say who counts as an authorized person.

Use & Processing · User right or choice

Members can request that PHI not be used for treatment, payment or healthcare operations, but Anthem may say no

The member can send Anthem a written request not to use PHI for treatment, payment, or healthcare operations activities. Anthem may say no, but it will tell the member why in writing.

Supporting quotations

Send us a written request not to use your PHI for treatment, payment, or healthcare operations activities.

We may say “no” to your request, but we’ll tell you why in writing.

Qualifications & exceptions

• This is a right to ask; Anthem may refuse.

Not stated here

• The notice does not say when Anthem agrees.

Cross-references

• narrowed by (model-proposed): Members who pay in full out of pocket can ask for a restriction; Anthem may not agree in some cases — The out-of-pocket restriction right is a narrower case of asking that PHI not be used for treatment, payment or operations; for it, Anthem's room to say no is limited to cases where a claim is submitted or a law requires sharing.

Use & Processing · Company practice

Anthem, its affiliates and vendors may call or text using an autodialer or artificial voice

Anthem says it, including its affiliates and/or vendors, may call or text a member using an automatic telephone dialing system and/or an artificial voice, but only in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be about treatment options or other health-related benefits and services.

Supporting quotations

Calling or texting you

We, including our affiliates and/or vendors, may call or text you by using an automatic telephone dialing system and/or an artificial voice.

But we only do this in accordance with the Telephone Consumer Protection Act (TCPA).

The calls may be about treatment options or other health-related benefits and services for you.

Qualifications & exceptions

• Subject to the TCPA, an external law not supplied here.

Not stated here

• The notice does not say what the TCPA requires.