Notice of Privacy Practices
Effective Date: June 13, 2021
This Joint Notice of Privacy Practices (“Notice”) is being provided to you on behalf of Pivot Behavior
Health, LLC, (collectively referred to throughout this Notice as “we” or “our”) and describes how medical information about you may be used and disclosed, and how you can access this information. This notice also describes your rights as they pertain to your protected health information. Protected health information is any information that identifies you individually; more specifically, it is demographic information that relates to your past, present, or future physical or mental health condition and any related healthcare services.
STANDARD USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
In order to provide you with the most effective level of treatment, we will need to obtain your personal health information. We understand how sensitive and important this information is, and want to assure you that we will maintain it with the utmost degree of integrity by taking all reasonable precautions to protect it from any improper disclosures. That said, there are certain scenarios which may arise during the course of your treatment that will require us to share at least some of your personal information with other parties, both inside and outside of Pivot Behavioral Health, LLC. The purpose of this document is to ensure that you are completely aware of these scenarios and the options you have in determining how and when your protected health information is used.
The following are situations during which we may use and disclose your protected health information, without first obtaining your authorization.
For treatment. We may use and disclose medical information about you to provide you with healthcare treatment and related services. We may disclose medical information about you to healthcare providers and personnel who are providing or involved in providing healthcare to you (both within Pivot’s organization and externally). For example, should your care require treatment by an outside physician, we may provide that physician with your medical information if such information will enable the physician to better determine your care plan.
For payment. If you elect to have treatment covered by your insurance provider, we may use and disclose your protected health information so that we can receive payment for the services provided to you. Examples of payment related activities include making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.
For healthcare operations. We will disclose your protected health information as necessary and as permitted by law, for our healthcare operations. These operations include clinical improvement, professional peer review, business management, accreditation and licensing, and other activities necessary to maintain optimal levels of service.
To business associates. We may disclose your protected health information to our business associates, who provide us with services necessary to maintain business operations. We will only provide the minimum information necessary for these associates to perform their functions as it relates to business operations. For example, we may use a third-party merchant processor to assist in our credit card billing services, but this merchant will never have access to your medical record. Please understand that all of our business associates are obligated to comply with the same privacy and security laws that we adhere to. Additionally, all of our business associates are under contract with us and are committed to protecting the privacy and security of your protected health information.
For appointments and services. We may contact you to provide appointment updates or information about your treatment, or other health-related benefits and services that may be of interest to you. You have the right to request, and we will accommodate reasonable requests, regarding how you want to receive communications as it pertains to your protected health information. For instance, if you wish appointment reminders not to be sent to a particular email address, we will not do so.
To preserve your safety and that of others. Your protected health information may be disclosed to the appropriate governmental agency if there is belief that a patient has been or is currently the victim of abuse, neglect, or domestic violence and the patient agrees to the disclosure, or if the provider is required by law to report the suspected abuse. In addition, your information may also be disclosed to prevent a serious threat to your health or safety or to the health and safety of others.
During judicial and administrative proceedings. As sometimes required by law, we may disclose your protected health information for the purpose of litigation, which includes, but is not limited to, responding to a court or administrative order or responding to a subpoena. Your information may also be disclosed if required for our legal defense in the event of a lawsuit.
For research. Occasionally we engage in research to support ongoing medical and treatment insights. All published findings include only fully anonymized data, but certain research collaborators may require access to protected health information for the purposes of confidential data analysis. Rest assured that these researchers are bound to the same confidentiality and privacy rules that govern Pivot as a whole.
For workers’ compensation claims. We may disclose a limited amount of your protected health information when necessary to comply with a workers’ compensation request. This information may be reported to your employer and/or your employer’s representative regarding an occupational injury or illness.
If practice ownership changes. If Pivot were ever to be sold, acquired, or merged with another healthcare entity, your protected health information will become the property of the new entity. In such a case however, you will retain all of the rights to your protected health information as set forth by this Notice and may request that copies of your medical record be transferred to another physician or healthcare group.
For breach notification purposes. If for any reason there is an unsecured breach of your protected health information, we will utilize the contact information you have provided us with to notify you of the breach, as required by law. In addition, your protected health information may be disclosed to the Department of Health and Human Services as a part of the breach notification and reporting process.
If you become incarcerated. If you are or become an inmate of a correctional facility, we may disclose requested protected health information to the correctional facility if the disclosure is necessary for your institutional healthcare, to protect your health and safety, or to protect the health and safety of others within the correctional facility.
For other uses and disclosures. We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization under the following circumstances.
* For public health activities or in connection with public health investigations;
* To a governmental oversight agency conducting audits, investigations, or pursuing information in connection with civil or criminal proceedings;
* To coroners or funeral directors, when the request is appropriate and made consistent with law;
* If you are a member of the military, for national security or intelligence activities; and
* For any other purpose required by law.
USES AND DISCLOSURES WE ARE PERMITTED TO MAKE UNLESS YOU NOTIFY US OTHERWISE
We may, under the following circumstances, use and disclose your protected health information without first receiving your authorization, unless you tell us not to do so, in which case we never will unless required by law enforcement or a court order. If you decide for any reason that you do not want your protected health information to be shared in some or all of these situations, please notify Pivot’s Member Support team, either through your Pivot account, or via email to 
To contact individuals involved in your care. We may from time to time disclose your protected health information to designated family, friends and others who are involved in your care or in payment of your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited amounts of your protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION
We will never disclose or use your protected health information in the following situations without first obtaining your written authorization to do so. In addition to the uses and disclosures listed below, other uses not covered in this Notice will be made only with your written authorization. If you provide us with authorization, you may revoke it at any time by submitting a request in writing.
To disclose psychotherapy notes. We must obtain your specific written authorization prior to disclosing any psychotherapy notes unless otherwise permitted by law. However, there are certain purposes for which we may disclose psychotherapy notes without obtaining your written authorization, which include the following scenarios.
* To carry out certain treatment, payment or healthcare operations (e.g. to defend ourselves in a legal action or other proceeding brought by you);
* To the Secretary of the Department of Health and Human Services as required by law;
* For health oversight activities authorized by law; or
* To medical examiners or coroners as permitted by law.
To disclose information about substance use disorders. Unless otherwise obligated by law, we must obtain your written authorization to disclose any information we maintain about your personal use with drugs or alcohol.
RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION
The following are statements of your rights, subject to certain limitations, with respect to your protected health information.
You have the right to obtain and inspect a copy of your medical record. You have the right to obtain and inspect a copy of the protected health information that we retain on your behalf, and may request a copy of such health information in a reasonable electronic format, if readily producible. Requests for access must be made in writing and signed by you or your legal representative. You also have the right to request that a copy of your medical record be sent to another individual or organization. We will make every attempt to provide the records in the specific format you request; however, in the case that the information is not readily accessible or producible in the requested format, we will provide the record in a standard electronic format or a hard copy form. To request that a copy of your medical record be sent to you or another party, please complete an Authorization Request for Release of Medical Records form by requesting a copy from Pivot’s Member Support team.
You have the right to request that your medical record be amended. You have the right to request in writing that your protected health information be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. If an amendment or correction request is honored, we may notify others who work with us if we believe that such notification is important for your healthcare needs. To submit a medical records amendment request, please contact Pivot’s Member Support team.
You have a right to receive an accounting of certain disclosures. You have the right to receive a list of certain disclosures that we have made of your information over the course of the prior six (6) years from the date on which you submit your request. Please note this request will not include disclosures made for the purposes of treatment, payment, healthcare operations; notification and communication with family and/or friends; and those disclosures required by law. To receive a copy of this disclosure log, please contact Pivot’s Member Support team.
You have the right to receive a notice of breach. We take very seriously the confidentiality of our patients’ information, and we are required by law to protect the privacy and security of your protected health information through appropriate safeguards. We will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to take to protect yourself.
You have the right to request restrictions of your protected health information. You have the right to request restrictions on uses and disclosures of your protected health information for treatment, payment, or healthcare operations purposes. While we are not required to agree to most restriction requests, we will still attempt to accommodate reasonable requests when appropriate. You do however have the right to restrict disclosure of your protected health information to your health plan if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law, and the protected health information pertains solely to a healthcare item or service for which you, or someone other than the health plan on your behalf, has paid us for in full. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as we deem appropriate, and will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw any restriction you may have previously requested. Should you wish to restrict your protected health information from disclosure, please contact Pivot’s Member Support team.
You have a right to request how you receive confidential communications. You have a right to request confidential communications from us by alternative means or at an alternative location. For example, you may designate we send email only to an address specified by you which may or may not be your primary email address. You may indicate we should only call you on your work phone or specify which telephone numbers we are or are not allowed to leave messages on. You do not have to disclose the reason for these requests; however, you must submit a request with specific instructions in writing to Pivot’s Member Support team.
You have a right to receive a paper copy of this notice. Even if you have agreed to receive an electronic copy of this Privacy Notice, you have the right to request we provide it in paper form. You may make such a request at any time by contacting Pivot’s Member Support team.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time, and will inform you of such changes should they be made.
COMPLAINTS
If at any time you believe your privacy rights have been violated and you would like to register a complaint, you may do so either with us or with the Secretary of the United States Department of Health and Human Services. Pivot WILL NEVER RETALIATE AGAINST YOU FOR MAKING A COMPLAINT. To lodge a complaint to Pivot directly, please contact the organization’s Privacy Officer, whose information is provided at the end of this document.
If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, please go to the website of the Office for Civil Rights (www.hhs.gov/ocr/hipaa/), call 202-619-0257 (toll free 877-696-6775), or send a letter to:
Secretary of the US – Department of Health and Human Services
200 Independence Ave S.W.
Washington, D.C. 20201
For further information from Pivot. If you have questions or need further assistance regarding this Notice, or if you would like to notify us directly about a privacy concern or violation, you may contact Pivot’s Compliance Department, by emailing Info@PBH.health. Additionally, you can contact Member Services through your patient portal, by emailing Info@PBH.health. This Notice is also readily available on our website at https://www.pbh.health/npp/.