Billing, Health Records & Patient Rights - Lifespan Comprehensive Sickle Cell Center

Future Students

Undergraduate Students

Graduate Students

Parents & Family

Alumni

Faculty & Staff

Researchers

Patients

Colleges & Schools

Billing and Insurance for UAB Hospital

The Lifespan Comprehensive Sickle Cell Center follows the insurance guidelines of UAB Hospital.

The UAB Health System provides the highest quality care for each of its patients. Each patient is recognized as an individual with unique psychological, spiritual, and cultural values. Our physicians and staff are committed to patient involvement in care.

You will be asked for your insurance information when you seek service at each UAB Medicine facility, including UAB Hospital, University Emergency Department, and The Kirklin Clinic of UAB Hospital. Specialist are available to guide you through your concerns about insurance and billing.

Patient Responsibilities & Rights

Notice of Health Information Practices
Note: The following information is available for download in PDF format >>

UAB HEALTH SYSTEM — UAB Hospital, The Kirklin Clinic of UAB Hospital, The Kirklin Clinic of UAB Hospital at Acton Road, UAB Health Centers, the University of Alabama Health Services Foudnation P.C. (Health Services Foundation) owned and operated clinics, community physicians who are on the UAB Health System Medical and Dental Staff pursuant to the UAB Health System Medical and Dental Staff Bylaws.

NOTICE OF HEALTH INFORMATION PRACTICES

Effective Date: April 14, 2003

Dates Amended: April 1, 2006; September 23, 2013; March 1, 2014

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

WHO WILL FOLLOW THIS NOTICE

This Notice describes the health informaton practices of certain members of the UAB Health System, including UAB Hospital, The Kirklin Clinic of UAB Hospital, The Kirklin Clinic of UAB Hospital at Acton Road, UAB Health Centers, the University of Alabama Health Services Foundation P.C. (Health Services Foundation) owned and operated clinics, and community physicians who are on the UAB Health System Medical and Dental Staff pursuant to the UAB Health System Medical and Dental Staff Bylaws (referred to as "UAB Health System"). All these entities, sites, and locations follow the terms of this Notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment, or health care operations purposes described in this Notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at UAB Health System. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the UAB Health System, whether made by clinic/hospital personnel or your personal doctor. This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
- make sure that medical information that identifies you is kept private;
- give you this Notice of our legal duties and privacy practices with respect to medical information about you;
- notify you in the case of a breach of your identifable medical information; and
- follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment and Treatment Alternatives. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical residents or students, or other UAB Health System personnel or people outside our facility who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of UAB Health System also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside UAB Health System who may be involved in your medical care after you leave, such as your local physician, family members, clergy, or others we use to provide services that are part of your care. We may use and disclose your medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- For Alabama One Health Record System. We participate in the State of Alabama's Health Information Exchange, known as One Health Record, that allows us to exchange electronic health information with hospitals, physicians, and other network participants who share in the System in the event we need to see or receive the information to treat you. Our participation in the System helps improve the quality of care you receive. You may choose not to have your electronic health information included in the System by submitting a written request on the required form to the Entity Privacy Coordinator.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive through UAB Health System may be billed to and payment may be collected from you, an insurance compoany, or a third party. For example, we may need to give your health plan information about surgery you received at UAB Health System so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your paln will cover the treatment.
- For Routine Health Care Operations. We may use and disclose medical information about you for UAB Health System routine operations. These uses and disclosures are necessary to run UAB Health System and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many UAB Health System patients to decide what additional services UAB Health System should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical residents and students, and UAB Health System personnel for review and learning purposes. We may also combine the medical information we have with medical information from other entities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove informationthat identifies you from this set of medical information so others may use it study health care and health care delivery without learning who the specific patients are.
- Individuals Involved in Your Care or Payment for Your Care. We may relsease medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
- Appointment Reminders and Health-Related Benefits and Services. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at UAB Health System. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Research. Under certain circumstances, we may use and disclose medical information about you to researchers when their clinical research study has been approved by UAB's or the facility's Institutional Review Board. While most clinical research studies require specific patient consent, there are some instances where patient authorization is not required. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those received another, for the same condition. This would be done through a retrospective record review with not patient contact. The Institutional Review Board reviews the research proposal to make certain that the proposal has established protocols to protect the privacy of your health information.
- Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for UAB Health System. We may disclose medical information to a foundation related to UAB Health System so that the foundation may contact you in raising money for UAB Health System. For example, we may use or disclose the following information to contact you for fundraising purposes: your name, address and phone number, the physicians who furnished the services, and the location and dates you received treatment or services at UAB Health System. If you do not want UAB Health System to contact you for fundraising efforts, you have the right to opt out of fundraising communications, as described in every fundraising communication.
- Certain Marketing Activities. UAB Health System may use medical information about you to forward promotional gifts of nominal value, to communicate with you about services offered to UAB Health System, to communicate with you about case management and care coordination, and to communicate with you about treatment alternatives. We do not sell your health information to any third party for their marketing activities unless you sign an authorization allowing us to do this.
- UAB Health System Directory. We may include certain limited information about you in the UAB Health System directories while you are a patient at UAB Health System, unless you request otherwise. This information may include your name, location in UAB Health System, your general condition (e.g. fair, stable, etc.), and your religious affiliation. The directory information, except for religious affiliation, may also be released to people who ask for you by name. This information and your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends, and clergy can visit you and generally know how you are doing.
- Business Associates. There are some services provided in UAB Health System through contracts with business associates. Examples include a copy service we use when making copies of your health record, consultants, accountants, lawyers, medical transcriptionists, and third-party billing companies. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.
- As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.
- Public Health Activities. We may disclose medical information about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, we are required to report the existence of a communicable disease, such as tuberculosis, to the Alabama Department of Public Health to protect the health and well-being of the general public. We may disclose medical information about you to individuals exposed to a communicable disease or otherwise at risk for spreading the disease. We may disclose medical information to an employer if the employer requires the healthcare services to determine whether you suffered a work-related injury.
- Food and Drug Administration (FDA). We may disclose to the FDA and to manufacturers health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.
- Victims of Abuse, Neglect, or Domestic Violence. We are required to report child, elder, and domestic abuse or neglect to the State of Alabama.
- Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. We may disclose medical information for judicial or administrative proceedings, as required by law.
- Law Enforcement. We may release medical information for law enforcement purposes as required by law, in response to a valid subpoena, for identification and location of fugitives, witnesses, or missing persons, for suspected victims of crime, for deaths that may have resulted from criminal conduct, and for suspected crimes on the premises.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
- Organ and Tissue Donation. If you are an organ donor, we may use or release medical information to organizations that handle organ procurement or other entities engaged in procurement, banking, or transportation of organ, eye, or tissue to facilitate organ or tissue donation and transplantation.
- To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by miliatry command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose medical information about you to authroized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations.
- Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution of law enforcement official.
- Other uses and disclosures. We will obtain your authorization to use or disclose your psyhcotherapy notes (other than for uses permitted by law without your authroization); to use or disclose your health information for marketing activities not described above; and prior to selling your health information to any third party. Any uses and disclosures not described in this Notice will be made only with your written authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

Although all records concerning your hospitalization and treatment obtained at UAB Health System are the property of UAB Health System, you have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Entity Privacy Coordinator. If you request a copy (paper or electronic) of the information, we will 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 in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another physician chosen by UAB Health System will review your request and denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request and amendment for as long as the information is kept by or for the entity.
To request an amendment, your request must be made in writing on the required form and submitted to the Entity Privacy Coordinator. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the medical information kept by or for the entity;
- is not part of the information which you would be permitted to inspect and copy; or
- is accurate and complete.
- Right to an Accounting Disclosures. You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing on the required form to the Entity Privacy Coordinator. Your request must state a time period which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restriction. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing on the required form to the Entity Privacy Coordinator. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
- Right to Request That Health Information Pertaining to Services Paid Out of Pocket Not Be Sent to Insurance or Other Health Plans. In some instances, you may choose to pay for a healthcare item or service out of pocket, rather than submit a claim to your insurance company. You have the right to request that we not submit your health information to a health plan or your insurance company, if you, or someone on your behalf, pay for the treatment or service out of pocket in full. To request this restriction, you must make your request in writing on the required form to the Entity Privacy Coordinator prior to the treatment or service. In your request, you must tell us (1) what information you want to restrict (2) and to what health plan the restriction applies.
- Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing on the required form to the Entity Privacy Coordinator. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Revoke Authorization. You have the right to revoke your authorization to use or disclose your medical information except to the extent that action has already been taken in reliance on your authorization.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
You may obtain a copy of this Notice at www.uabmedicine.org. To obtain a paper copy of this Notice, contact the Entity Privacy Coordinator.

CHANGES TO THIS NOTICE
- We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in UAB Health System facilities. The Notice will contain the effective date on the first page. In addition, each time you visit UAB Health System to receive services, we will make available a copy of the current Notice in effect.
FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions and would like additional information, you may contact the Entity Privacy Coordinator. If you believe your privacy rights have been violated, you may file a complaint with UAB Health System or with the Secretary of the Department of Health and Human Services. To file a complaint with UAB Health System, contact the Entity Privacy Coordinator. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

NOTICE EFFECTIVE DATE

The effective date of the Notice is April 14, 2003, amended on April 1, 2006, September 23, 2013, and March 1, 2014.

Entity Privacy Coordinators

UA Health Services Foundation (The Kirklin Clinic of UAB Hospital)

Privacy Coordinator
500 22nd Street South, Suite 504
Birmingham, AL 35233-2023
205.801.8029

UAB Hospital
Privacy Coordinator
Old Hillman Building, Room 225
619 19th Street South
Birmingham, AL 35249-6543
205.975.0585

Additional Notices of Health Information Practices:
UAB Callahan Eye Hospital & Clinics