Member Confidentiality

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Members are entitled to confidential treatment of member communications and records. Case discussion, consultation, examination, and treatment are confidential and are to be conducted discreetly. Written authorization from the member or an authorized legal representative must be obtained before medical records are released to anyone not directly concerned with care, except as permitted or necessary in the administration of the health plan.

Office Procedure

All participating providers must maintain an office procedure that guards against unauthorized disclosure of confidential member information. This procedure should contain the following elements:

  • Written authorization from the member or a legal representative before medical records are made available to anyone not directly concerned with care, except where otherwise permitted or required by law or subpoena
  • All signed authorizations for release of medical information, which have been reviewed for specific authorization and for any limitations
  • Each medical record, which has been reviewed prior to making it available to anyone other than the member or legal representative
  • Only the portion of the medical record specified in the authorization, which has been made available to the requester and is separated from the remainder

Any portion of the medical record not covered by the authorization must be withheld.

Physicians are encouraged to have their office staff sign a confidentiality statement to ensure that they understand their responsibility in maintaining member confidentiality.

Release of Medical Information Form

All providers should maintain a proper Release of Medical Information form (PDF) for all record requests in the member's medical record.