CONFIDENTIALITY

Confidentiality of Medical Records
In general, HMOs may not disclose any medical information of a member or applicant without his or her prior consent. There are some limited circumstances when the consent of the patient is not needed. HMOs can release medical information by court order. HMOs can also release medical information in the event of litigation between the HMO and member if the information is relevant to the case. Medical information can be shared within the HMO so that the HMO can assess the appropriateness of the care provided or monitor quality. Any organization, which the HMO contracts with to help in these activities, is subject to these confidentiality provisions (NCGS 58-67-180, 11 NCAC 20.0408, 11 NCAC 20.0509, 11 NCAC 12.0916(a)).

HMOs, like all insurance carriers, are also subject to the Insurance Information and Privacy Act (NCGS 58-39-1 et. seq.). This statute sets rules for the collection, use and disclosure of medical information involving insurance transactions. For example, health plans may seek information about your medical history before offering you certain types of non-group health insurance. Applicants and members have the right to examine this information for accuracy. Also, you can find out the reason why a health plan decides not to offer you insurance coverage (NCGS 58-39-5).

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