If a health care service plan requests medical information from providers in order to determine whether to approve, modify, or deny requests for authorization of services, the plan shall request only the information reasonably necessary to make the determination.
A provider of health care or a health care service plan may disclose medical information in the following circumstances: 1) to other healthcare providers to facilitate diagnosis and treatment 2) to find financially liable party and obtain payment 3) to administrative subcontractors 4) quality control organizations (peer review boards, etc.) 5) accrediting agencies 6) coroners 7) \bona fide research purposes\" 8) employer
No provider of health care, health care service plan, or contractor shall disclose medical information regarding a patient of the provider of health care or an enrollee or subscriber of a health care service plan without first obtaining an authorization, except as provided in subdivision (b) or (c).
No provider of health care, health care service plan, or contractor may require a patient, as a condition of receiving health care services, to sign an authorization, release, consent, or waiver that would permit the disclosure of medical information that otherwise may not be disclosed.
A health care service plan shall not release any information indicating an employee is receiving services from a health care provider under the plan to an employer, unless the employee authorizes the plan to do so.
No contract between a plan and health care provider for the provision of health care services shall include a requirement to permit access to patient information in violation of laws regarding the confidentiality of patient information.
A disease management organization shall not use medical information obtained pursuant to 1399.903, to solicit or to offer products or services to a health care services plan enrollee.
Every health care service plan shall provide an external, independent review process to examine the plan's coverage decisions regarding experimental or investigational therapies for individual enrollees with a life-threatening or seriously debilitating condition. The enrollee's physician must certify that the enrollee has a condition for which standard therapies are not effective or medically appropriate; the physician certification shall include a statement of the evidence relied upon by the physician in certifying his or her recommendation.
Exemptions from Public Records Act disclosure include confidentiality of records and claims relating to group insurance for local government employees.
