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ADAP - Notice of Uninsured Care Programs Privacy Practices

Notice of Uninsured Care Programs Privacy Practices

This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access to this Information. Please Review it Carefully.

Under Federal and New York State Law, the Uninsured Care Programs are required to protect the privacy of your personal health-related information, (including medical and billing information and information which is used to make decisions about you) and follow the terms of this notice. Health-related information and personal identifiers provided to the Programs are kept strictly confidential.

The Uninsured Care Programs are also required to give you this notice to tell you how the Uninsured Care Programs may use and give out (disclose) your health-related information held by Uninsured Care Programs. If the Uninsured Care Programs make any changes to the way your health-related information is used and given out, you will get a new notice by mail. Program staff are aware of your needs for confidentiality and privacy and will disclose personal information only as necessary for the administration of the programs.

Uninsured Care Programs must use and give out your health-related information:

  • To you or someone who has the legal right to act for you (for example, your health care proxy or a person designated by a specific release signed by you);
  • To the New York State Commissioner of Health and the Federal Office of Civil Rights, if necessary, to make sure your privacy is protected; and
  • When specifically required by law, for example, for health-care oversight activities.

With your permission the Uninsured Care Programs may use and give out your health-related information, for example:

  • To pay for your health care, to provide customer services to you, to resolve any complaints you have and to operate the Uninsured Care Programs;
  • To pay, deny and audit claims for services and coordinate benefits obtained by you;
  • To pay health insurance premiums and to bill other insurance carriers, including Medicaid as you specify;
  • To our business associates who assist us in normal business operations; for example, outside auditors, provided they agree to keep your information confidential;
  • To avoid a serious and imminent threat to health or safety;
  • To contact you about new or changed benefits under the Uninsured Care Programs; and
  • To contact you about new treatment information or obtain your comments.
  • See and get a paper copy of this notice, or a copy of your personal health-related information held by the Uninsured Care Programs; if you are denied your request for health information, you have the right to seek a review of the denial. The information maintained by the Uninsured Care Programs includes:
    • The Program enrollment application;
    • The medical application form completed by your health care provider;
    • Claim and payment information (up to 7 years only); and
    • Medical information submitted by your health care provider for prior approval medications or services.
  • Request to have your personal health-related information amended. If the Uninsured Care Program disagrees with your request (for example, if the information is accurate), you may have a statement of your disagreement added to your personal health-related information.
  • Get a listing of those receiving your personal health-related information from the Uninsured Care Programs. The listing will not cover your personal health-related information that was given out to pay for your healthcare, health insurance or for the operation of the Uninsured Care Programs.
  • Ask the Uninsured Care Programs to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. Box instead of your home address).
  • Ask the Uninsured Care Programs to limit how your personal health-related information is used and given out to pay your claims and operate the Uninsured Care Programs. Please note that the Uninsured Care Programs may not be able to agree to your request.
  • By law, the Uninsured Care Programs must have your written permission (“authorization”) to use or give out your personal health-related information for any purpose that is not set out in this notice. You may take back (revoke) your written permission at any time, by sending a written notice of revocation.

    You can obtain more information about the program or exercise your rights by calling the Privacy Office at the Albany number below or by viewing web information at If you believe the Uninsured Care Programs have violated your privacy rights set out in this notice, you may send your complaint about the Uninsured Care Programs to either of the addresses below:

    • Privacy Officer
      Empire Station
      P.O. Box 2052
      Albany, New York 12220
      Phone: (800) 542-2437
      TTY (518) 459-0121
    • Office of Civil Rights
      Department of Health and Human Services
      Jacob Javits Federal Building
      26 Federal Plaza Suite 3312
      New York, New York 10278
      Phone (212) 264-3313
      Fax (212) 264-3039

    Filing a complaint will not affect or subject you to any adverse action or affect your program eligibility under the Uninsured Care Programs.

    For more information call the Uninsured Care Programs 1-800-542-2437