Privacy Notices

Your Rights Regarding Your Protected Health Information

The following is a description of your rights with respect to your protected
health information.

Right to Request a Restriction. You have the right to request a restriction on the protected health information we use or disclose about you. We are not required to agree to any restriction that you may request. If we do agree to the restrictions we will comply with the restriction, unless the information is needed to provide emergency treatment to you. You may request a restriction by writing. In your request tell us: (1) the information whose disclosure you want to limit and (2) how you want to limit our use and/or disclosure of the information.

Right to Request Confidential Communications. If you believe that a disclosure of your protected health information may endanger you, you may request that we communicate with you regarding your information in an alternative manner or at an alternative location. For example, you can ask that we only contact you at your work address or via your work e-mail. You may request a restriction by writing. In your request tell us: (1) the parts of your protected health information that you want us to communicate with you in an alternative manner or at an alternative location and (2) that the disclosure of all or part of the information in a manner inconsistent with your instructions would put you in danger.

Right to Inspect and Copy. In most cases, you have the right to inspect and copy your protected health information that is contained in a "designated record set.' Generally, a "designated record set' contains medical and billing records, as well as other records that are used to make decisions about your health care benefits. To inspect and copy your protected health information that is contained in a designated record set, you must submit your request in writing. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy your protected health information in certain circumstances. If you are denied access to your information, we will inform you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

Right to Amend. If you believe that your protected health information is incorrect or incomplete, you may request that we amend your information. You may request that we amend your information by writing, and should include the reason the amendment is necessary. In certain cases, we may deny your request for an amendment. For example, we may deny your request if the information you want to amend is not maintained by us, but by another entity. If we deny your request, you have the right to file a statement of disagreement with us. Your statement of disagreement will be linked with the disputed information and all future disclosures of the disputed information will include your statement.

Right to an Accounting. You have a right to an accounting of most disclosures of your protected health information that are for reasons other than payment, treatment, or health care operations. An accounting will include the date(s) of the disclosure, to whom we made the disclosure, a brief description of the information disclosed, and the purpose for the disclosure. You may request an accounting by submitting your request in writing. Your request may be for disclosures made up to 6 years before the date of your request, but in no event, for disclosures made before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.

Right to This Notice. You have the right to receive a copy of this Notice by e-mail. You have the right to a paper copy of this Notice, even if you have agreed to accept this Notice electronically.

To fulfill any of the above requests in writing, send the description of your request to: FirstCare Health Plans, Legal Department, Attn. Jimmy Seale, 12940 N. Highway 183, Austin, Texas 78750.



  • We Have a Legal Duty to Safeguard Your Protected Health Information

  • How We May Use and Disclose Your Protected Health Information

  • Other Uses and Discloses of Your Protected Health Information

  • How to Complain About Privacy Practices