Customer Service Privacy
Customer Service strives to assist all callers upon their first contact with us; however, there are certain instances when we may need authorization to speak to someone regarding another person's Protected Health Information (PHI). Federal regulations restrict who can receive PHI about our members in order to protect their privacy.
- Who can access my PHI?
- My child is over the age of 12, why do I need their authorization to speak about certain claims?
- What if I want to allow someone else to access my PHI?
- What if I submitted an ARI for someone, but I don't want them to have access to my information anymore?
1. Who can access my PHI?
- If the patient is under age 12, the subscriber or an adult who is on the same policy can access that patient's PHI, including membership, benefits, billing, and specific claims information (including sensitive claims information).
- If the patient is age 12 or older, the subscriber or an adult who is on the same policy can access that patient's membership, benefits, billing and specific claims information as long as it does NOT involve sensitive claims information.
- Adult children and spouses of elderly patients can receive information concerning that patient's membership, benefits, billing and specific claims information as long as it does NOT involve sensitive claims information. An elderly patient is defined as an individual who is over the age of 65, no longer working, and has difficulty carrying out daily activities. We encourage anyone repeatedly calling on behalf of an elderly patient to have an ARI submitted by the elderly patient giving authorization for them to access the elderly patient's PHI.
2. My child is over the age of 12, why do I need their authorization to speak about certain claims?
State and Federal law limits the access of PHI of minors age 12 and over without express authorization from the minor child.
3. What if I want to allow someone else to access my PHI?
- If you want to allow someone to access your PHI and sensitive claims information you should submit an Authorization to Release Information (ARI) form.
- If you need someone to contact Customer Service on your behalf immediately, Customer Service can take a verbal authorization from you over the phone. Verbal authorizations are only good until the end of business on the day you called.
- There are additional forms and legal documents which are also acceptable as a substitute for an ARI, however these documents must be reviewed by our Legal Department. Some of these documents include Power of Attorney, Appointment of Executorship or Appointment of Guardianship. Please contact Customer Service at the number on the back of your ID card for assistance.
4. What if I submitted an ARI for someone, but I don't want them to have access to my information anymore?
You can revoke the authorization at any time using the Authorization to Release Information - Revocation form or by mailing a written notice of your revocation to BCBSVT ATTN: Privacy Officer at PO Box 186 Montpelier, VT 05601.
Plan Definitions
Protected Health Information (PHI) Includes any of the following information sources which are specific to an individual or could reasonably be used to identify an individual:
• Medical information, procedures, and records;
• Patient diagnosis and prognosis;
• Claims information;
• Demographic information including address; and
• Patient and provider identities.
This definition includes all information, whether maintained in electronic, oral or paper format.
Specific Claims Information A category of PHI, which may be disclosed to certain persons in certain situations. Specific Claims Information includes:
• Membership status of Patient;
• Allowed benefits;
• Whether a benefit was paid;
• Dates of payment;
• Out of Pocket maximum information (but not who or how the out of pocket maximum has been met); and
• Total deductible met year to date (but not who or how the deductible has been met).
Sensitive Claims Information Includes treatment related to drug and alcohol abuse, mental health, AIDS, HIV status, pregnancy (but not delivery), abortion, fertility treatment, contraception (i.e. surgical procedures and drugs), and sexually transmitted diseases. BCBSVT may, at our discretion, deem other circumstances to fall into this category.