How We May Use and Share PHI About You

L.A. Care collects, uses or shares PHI that is provided to us as allowed by law for treatment, payment, and health care operations associated with the program in which you are enrolled.

The PHI we use and share includes, but is not limited to:

  • Name
  • Address
  • Date of birth
  • Care and treatment received
  • Health history
  • The cost of/payment for care
  • Race/ethnicity
  • Language
  • Sex assigned at birth
  • Gender identity
  • Sexual orientation; and
  • Pronouns

Ways In Which We Typically Use and Share PHI

We generally use and share PHI in the following ways:

  • Treatment: We do not provide treatment, but we can use and share PHI with health care and other service providers such as doctors, hospitals, durable medical equipment suppliers, and others to offer you care, and treatment and other services, and information to help you.
  • Payment: We can use and share PHI with healthcare providers, service providers and other insurers and payors to process requests for payments, and pay for health services provided to you.
  • Health Care Operations: We can use and share PHI to run our organization and contact you when necessary, for example for audits, quality improvement, care management, coordinating care, and day-to-day functions. We may also use and share PHI with State, Federal, and County programs for participation, and program administration.

Some Examples of Ways We Use PHI:

  • To give information to a doctor or hospital to confirm your benefits, copay, or deductible.
  • To approve care in advance.
  • To process and pay claims for health care services and treatment you received.
  • To give PHI to your doctor or hospital so they can treat you.
  • To review the quality of care and services you receive.
  • To help you and provide you with educational and health improvement information and services, e.g. for conditions like diabetes.
  • To inform you of additional services and programs that may be of interest to you and/or help you, e.g. a fitness class at an L.A. Care Community Resource Center.
  • To remind you to get regular health assessments, screenings, or checkups.
  • To develop quality improvement programs and initiatives, including creating, using, or sharing de-identified data as allowed by HIPAA.
  • To use and share information, directly or indirectly, with health information exchanges, for treatment, payment, and health care operations.
  • Investigating and prosecuting cases, such as for fraud, waste, or abuse.