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Summary:

No provider of health care, health care service plan, or contractor shall disclose medical information regarding a patient of the provider of health care or an enrollee or subscriber of a health care service plan without first obtaining an authorization, except as provided in subdivision (b) or (c).

Summary:

Provides civil penalties for willful or negligent disclosure of results of a test for a genetic characteristic that are contained in the medical record of an applicant or enrollee of a health care service plan

Summary:

The Public Records Act exempts from disclosure genetic test results in medical record of applicant or enrollee of specified insurance plans.

Summary:

Every health care service plan that provides, operates, or contracts for telephone medical advice services to its enrollees and subscribers must maintain records of its telephone medical advice services for a period of 5 years after the services are provided, including oral or written transcripts of all medical advice conversations with the health care service plan's enrollees or subscribers in California and copies of all complaints. If the records of telephone medical advice services are kept out of state, the health care service plan shall, upon the request of the director, provide the records to the director within 10 days of the request.

Summary:

Every health care service plan shall, upon request, provide to enrollees and subscribers a written statement that describes: how it protects confidential medical information; types of medical information it collects; purposes for which it collects the info; when the information may be disclosed without prior authorization; and how patients may obtain access to this information.

Keywords:
enrollee
Summary:

(a) Health care service plans must provide a grievance system for enrollees. The plan must maintain a log of the grievances, including the date, name of complainant, member ID, and nature of the grievance and resolution. The plan must maintain in its files all grievances and responses for five years. (b) After 30 days of participation in the insurance plan's grievance process, enrollees can submit their grievance to the Department of Managed Health Care for review. The department may refer any grievance that does not pertain to compliance with this chapter to the State Department of Public Health, the California Department of Aging, the federal Health Care Financing Administration, or any other appropriate governmental entity for investigation and resolution. If the subscriber or enrollee is a minor, or incompetent or incapacitated, the parent, guardian, conservator, relative, or other designee of the subscriber/enrollee, may submit the grievance to the department as the subscriber/enrollee's agent. The department must send written notice of the final disposition of the grievance to the enrollee within 30 days of receipt of the request for review, unless the director determines that additional time is reasonably necessary to fully evaluate the grievance. (c) The plan's grievance system shall include a system of aging of grievances that are pending and unresolved for 30 days or more. The plan shall provide a quarterly report to the Director of the Department of Managed Health Care about such pending/unresolved grievances, with separate categories of grievances for Medicare enrollees and Medi-Cal enrollees. The plan shall include with the report a brief explanation of the reasons each grievance is pending and unresolved for 30 days or more.

Summary:

An enrollee may apply for an independent medical review of a decision to deny, modify or delay medical services. The health service plan shall provide the enrollee with an application form. The form shall include a statement indicating the enrollee's consent to obtain any necessary medical records from the plan, contracting providers, or any out-of-plan provider consulted on the issue that must be signed by the enrollee.

Summary:

Upon notice from the department that an enrollee has applied for an independent medical review, the plan or its contracting providers shall provide the requisite medical records (specified in (1) to (3)) to the independent medical review organization within 3 days. The confidentiality of any enrollee information shall be maintained in accordance with applicable laws.

Summary:

Upon receipt of information and documents related to a case, the independent medical review organization shall promptly review all pertinent medical records of the enrollee.

Summary:

A health care service plan must authorize or deny a second opinion from another health professional upon the request from an enrollee or health professional treating an enrollee. The health professional providing the second opinion must provide the enrollee and the initial health professional with a consultation report.

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