(888) 256-7636
Coast 2 Coast Medical Billing (“C2CMB”) is required by law to maintain the privacy of certain confidential
healthcare information, known as Protected Health Information or PHI, and to provide you with a notice of
our legal duties and privacy practices with respect to your PHI. C2CMB is also required to abide by the
terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: C2CMB may use PHI for the purposes of payment and health care operations, in
most cases without your written permission. Examples of our use of your PHI:
For payment. This includes any activities we must undertake in order to get reimbursed for the services our
clients provide to you, including such things as submitting bills to insurance companies, making medical
necessity determinations and collecting outstanding accounts.
For health care operations. This includes quality assurance activities, licensing, and training programs
to ensure that our personnel meet our standards of care and follow established policies and procedures, as
well as certain other management functions.
Use and Disclosure of PHI Without Your Authorization. C2CMB is permitted to use PHI without your written
authorization, or opportunity to object, in certain situations, and unless prohibited by a more stringent
state law, including:
For health care and legal compliance activities;
To a family member, other relative, or close personal friend or other individual involved in your care
if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure
and you do not raise an objection, and in certain other circumstances where we are unable to obtain your
agreement and believe the disclosure is in your best interests;
For judicial and administrative proceedings as required by a court or administrative order, or in some
cases in response to a subpoena or other legal process;
For law enforcement activities in limited situations, such as when responding to a warrant;
For military, national defense and security and other special government functions;
For workers’ compensation purposes, and in compliance with workers’ compensation laws;
To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause
of death, or carrying on their duties as authorized by law;
We may also use or disclose health information about you in a way that does not personally identify you
or reveal who you are.
Any other use or disclosure of PHI, other than those listed above will only be made with your
written authorization. You may revoke your authorization at any time, in writing, except to the
extent that we have already used or disclosed medical information in reliance on that authorization.
Patient Rights: As a patient, you have a number of rights with respect to your PHI, including:
The right to access, copy or inspect your PHI. This means you may inspect and copy most of the medical
information about you that we maintain on behalf of our clients. We will normally provide you with access
to this information within 30 days of your request. We may also charge you a reasonable fee for you to
copy any medical information that you have the right to access. In limited circumstances, we may deny you
access to your medical information, and you may appeal certain types of denials. We have available forms
to request access to your PHI and we will provide a written response if we deny you access and let you
know your appeal rights. You also have the right to receive confidential communications of your PHI. If
you wish to inspect and copy your medical information, you should contact our privacy officer.
The right to amend your PHI. You have the right to ask our clients to amend written medical information that
they may have about you. They will generally amend your information within 60 days of your request and will
notify you when they have amended the information. They are permitted by law to deny your request to amend
your medical information only in certain circumstances, like when they believe the information you have asked
them to amend is correct. If you wish to request that they amend the medical information that they have about
you, you should contact our privacy officer.
The right to request an accounting. You may request an accounting from us of certain disclosures of your
medical information that we have made in the six years prior to the date of your request. We are not required
to give you an accounting of information we have used or disclosed for purposes payment or health care
operations, or when we share your health information a medical facility from/to which our clients have
transported you. We are also not required to give you an accounting of our uses of protected health
information for which you have already given us written authorization. If you wish to request an accounting,
contact our privacy officer.
The right to request that we restrict the uses and disclosures of your PHI. You have the right to request
that we restrict how we use and disclose your medical information that we have about you. C2CMB is not
required to agree to any restrictions you request, but any restrictions agreed to by C2CMB in writing are
binding on C2CMB.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. If we maintain a web
site, we will prominently post a copy of this Notice on our web site. If you allow us, we will forward
you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.
Revisions to the Notice: C2CMB reserves the right to change the terms of this Notice at any time, and the
changes will be effective immediately and will apply to all protected health information that we maintain.
Any material changes to the Notice will be promptly posted in our facilities and posted to our web site, if
we maintain one. You can get a copy of the latest version of this Notice by contacting our privacy officer.
Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United
States Department of Health and Human Services if you believe your privacy rights have been violated. You will
not be retaliated against in any way for filing a complaint with us or to the government. Should you have any
questions, comments or complaints you may direct all inquiries to our privacy officer.
Privacy Officer Contact Information:
Sherry A. Tomasula
Coast 2 Coast Medical Billing
PO Box 7744, Laguna Niguel, CA 92607
888-256-7636
Effective Date of the Notice: October 1, 2011