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Health data permissions and privacy

Aetna Patient Access API Member Educational Resources Regarding Privacy and Security


Certain Aetnafootnote1 members have the right to direct Aetna to disclose their claims data, encounter data, and clinical data (collectively “health data”) held by Aetna or certain of its government program health plan subsidiaries and affiliates to a designated third-party application (app) through certain standardized technology.footnote2


Aetna is also required by law to provide these educational resources, which you may use when making decisions about who you choose to share your health data with.

 

Currently, only Medicare Advantage plan members may direct Aetna are able to give consent to share their health data with third party apps via Aetna's Patient Access API. Patient Access API functionality for certain other Aetna members will be available in the first half of 2021.

How you can help protect the privacy and security of your health data.

 

  • It is important for you to take an active role in protecting your own health data.
  • If you direct Aetna to share your health data with a third-party app, Aetna has no control over how the third-party app will use or share your health data. Aetna does not review or evaluate third-party apps or their privacy or security practices for your health data.
  • Some third-party apps may share your health data with other third parties.
  • Health data can be very sensitive, and you should be careful to choose apps with strong privacy and security standards to protect it.
  • Any app you choose to receive your health data should have an easy-to-read privacy policy that clearly explains how the app will use your data. If an app does not have a privacy policy, you should consider not using the app.
  • Before you direct Aetna to share your health data with an app, you should read carefully the app’s terms of use (sometimes this information is contained in the app’s “end user license agreement”) and privacy policy to understand how the app will use and share your health data.
  • Below are factors to consider when selecting an app to receive your health data. If an app’s privacy policy does not clearly answer these questions, you should reconsider allowing the app to access your health data.

Factors to consider when selecting a third-party app to receive your health data.

 

What is the Health Insurance Portability and Accountability Act (HIPAA)?

 

  • The Health Insurance Portability and Accountability Act (HIPAA) is a federal law. One part of it helps protect personal health information. The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) enforces the HIPAA Privacy, Security, and Breach Notification Rules, and the Patient Safety Act and Rule.
  • You can find HIPAA FAQs for individuals from HHS here: https://www.hhs.gov/hipaa/for-individuals/faq/index.html

Who must follow HIPAA?

 

  • Organizations and individuals who must follow HIPAA regulations are called “covered entities,” which can include:
    • Health plans, like health insurance companies, health maintenance organizations (HMOs), company health plans, and certain government programs that pay for health care, like Medicare and Medicaid
    • Many health care providers—those that conduct certain business electronically, such as electronically billing your health insurance—including most doctors, health clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists
    • Health care clearinghouses
  • Additionally, “business associates” who provide certain services for covered entities must follow parts of the HIPAA regulations. Examples of business associates include billing companies, health care claims processors, companies that store or destroy medical records, and those that help administer health plans.
  • Many organizations that have health information about you do not need to follow HIPAA rules. Examples of these organizations may include life insurers, employers, workers compensation carriers, many schools and school districts, many state agencies, many law enforcement agencies, and many municipal offices.
  • You can find more information from HHS about patient rights under HIPAA and who is obligated to follow HIPAA here: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.

 

Are third-party apps required to follow HIPAA rules?

 

  • Most third-party apps will not be covered by HIPAA. Most third-party apps will instead fall under the jurisdiction of the Federal Trade Commission (FTC) and the protections provided by the FTC Act.
  • The FTC Act, among other things, protects against deceptive acts, for example, when an app shares personal data without a user’s permission, despite having a privacy policy that says it will not do so.
  • The FTC provides information about mobile app privacy and security for consumers here: https://www.consumer.ftc.gov/articles/0018-understanding-mobile-apps.

HIPAA Privacy Complaints

 

  • If you think your HIPAA Privacy Rights have been violated, you can contact us using the toll-free Member Services number on your health plan ID card or you may contact the Aetna Privacy Office directly at the address below:

HIPAA Member Rights Team
Aetna Inc.
P.O. Box 14079
Lexington, KY 40512-4079

What should you do if you think an app has used your data inappropriately?

 

footnote1 “Aetna” and the pronouns “we,” “us,” or “our” may refer to one or more of the Aetna group of subsidiary companies and their affiliates.

 

footnote2 See The Centers for Medicare & Medicaid Services (“CMS”) Interoperability and Patient Access Final Rule (CMS-9115-F).