•Member Privacy Information
Notice of Privacy
This notice is to all Indiana Health Coverage Programs (IHCP)
members including Medicaid, Hoosier Healthwise, Medicaid Select,
and members residing in institutions operated by the Indiana
Department of Health and the division of Mental Health and
Addictions who have received medical services outside of those
institutions. This notice is for your information only. You do not
need to take any action as a result of this notice.
To view the Notice of Privacy Practices in English,
Para ver el Aviso de prácticas de privacidad en español, haga
Notice of 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.
IHCP will not share your health information without your written
permission except as described in this notice, or when required or
permitted by law. If you give us your written permission to share
your information with others you identify, you may change your mind
at any time by telling us in writing. The IHCP will comply with
this notice. The IHCP reserves the right to change its privacy
practices and make the new privacy practices effective for all
protected health information we maintain. If the terms of this
notice change we will notify you at the address you have
Our Responsibilities and Commitment to You
We understand that your health information is personal. We take
our responsibility to keep your personal health information private
very seriously. We are required by law to protect your health
information, to tell you about your rights regarding your health
information, and to give you this notice explaining our
responsibilities and the ways your health information will be used
and shared by the IHCP.
Use and Disclosure of Your Health
We do not create health records. We receive your health
information to help us make decisions about whether you qualify for
certain programs or services, to pay for services provided to you
by your health care provider, for health care operations, and to
evaluate the quality of services you receive. The following are
some common examples of how we may use your personal health
information without getting your specific written permission:
Doctors, hospitals, and other health care practitioners that
provide services to you submit your health information to us in the
form of a claim for payment. They may also give us your health
information to obtain prior authorization for a service or to find
out if a service is covered. These requests include information
that identifies you, your diagnosis, and procedures you have
received, or that you might receive in the future. We use this
information to approve and pay for the services that we cover. We
may also share your information with other programs that may pay
for your health care, such as Medicare or private insurance
companies in order to get payments.
•We may use your health information to review the care and
outcome of your treatment and to compare your outcomes with the
outcomes of other people who received the same or similar
treatment. We use this information to improve the quality and
effectiveness of health care services.
• We may share your health information with our employees, as
well as with contracted companies and persons, so they can perform
the jobs we ask them to do, such as approving services for you or
reviewing payments made to health care practitioners. To protect
your health information we require everyone who works for us or has
a contract with us to follow rules protecting your information.
• We may use or share your health information to tell you or
your provider about possible treatment options, alternative
treatments, and for other health-related benefits.
• We may share your health information with other government
agencies that may provide public benefits or services to you. We
may also share your information with other government agencies as
permitted by law, including the federal government, to show how the
IHCP is working and to improve its programs.
Your Health Information Rights
•You have the right to request that we restrict our use and
release of your health information for payment, treatment or health
care operations, or with family, friends, and others you identify.
We are not required to agree to your request. If we do agree, we
will abide by our agreement, except in a medical emergency or as
required or authorized by law. You should submit your request in
writing to the IHCP Privacy Office.
• You have the right to request a paper copy of this notice at
any time, even if you agree to receive it electronically by
• You have the right to a list of instances in which we released
your personal health information for purposes other than for
treatment, payment, and health care operations. This list will not
include information previously requested by you or anyone
authorized by you to receive your health information, and for
certain other activities. The list is limited to the last six years
and must be requested in writing to the IHCP Privacy Office.
• You have the right to request that we contact you about your
personal health matters in a certain way or at a certain location.
For example, you can request that we only contact you at work or by
e-mail. We will review and accommodate only reasonable requests. To
make a special contact request you must submit your request in
writing to the IHCP Privacy Office.
•You have the right to see and get a copy of your health
information with certain exceptions. We are permitted to charge a
reasonable fee for the costs of copying, mailing, or for other
supplies needed to meet your request. Your request must be
submitted in writing to the IHCP Privacy Office. If your request is
denied for some reason, you can file an appeal with the IHCP
Privacy Office. A person who did not participate in the decision to
deny your request will review your appeal.
• You have the right to ask that we change your health
information if you feel it is incorrect or incomplete. Your request
should be submitted in writing to the IHCP Privacy Office. We may
deny your request for only certain reasons, such as we did not
create the information or we believe the information is correct. If
we deny your request, we will provide you a written
Contact Information or Filing a Complaint
If you have questions, want additional information, or want to
make a request you can contact the IHCP Privacy Office at the
address or phone number below. All requests about your health
information must be submitted in writing.
If you have a complaint about our health information practices
or believe that we have violated your privacy rights, please submit
the complaint to the IHCP Privacy Office at the following
All complaints must be submitted in writing
IHCP Privacy Office
P.O. Box 7260
Indianapolis, IN 46207-7260
(317) 713-9627 or 1-800-457-4584
You can also file a complaint with the Office of Civil Rights,
U.S. Department of Health and Human Services at the following
Office of Civil Rights, Chicago
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 240
Chicago, Illinois 60601
Phone: (312) 886-2359; FAX: (312) 886-1807