Notice of Privacy Practices for Protected Health Information
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Rx HELP (herein referred to as Company) is dedicated to protecting your medical information. We are required by law
to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and
privacy practices with respect to protected health information.
Company is required by law to abide by the terms of this Notice.
We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health
information we maintain. If Company revises the terms of this Notice, it will post a revised notice at the Company and
will make paper copies of this Notice of Privacy Practice for Protected Health Information available upon request.
How Your Medical Information Will Be Used and Disclosed:
Company will use your medical information as part of rendering our prescription assistance services and functioning
as a health care advocate. For example, your medical information may be used by the health care professional
assisting you, by the business office to process your payment for the services rendered and by administrative
personnel reviewing the quality and appropriateness of the service you received.
Company may also use and/or disclose your information in accordance with federal and state laws for the following
purposes:
Company may contact you to provide appointment reminders or information about service alternatives or other
health-related benefits and services that may be of interest to you.
Company may use your personal and/or medical information to make referrals for other related services you may have
requested or may have been recommended to you.
Company may disclose medical information when required by the United States Department of Health and Human
Services as part of an investigation or determination of the Company's compliance with relevant laws.
Unless you object, Company may disclose your medical information to a Family member, Guardian, Power of
Attorney or Health Care Surrogate as related to the services being rendered if deemed necessary to complete
process for which services have been requested.
Company may disclose your medical information in the course of certain judicial or administrative proceedings as
required by law.
Company will not use or disclose your medical information for any other purpose without your written authorization.
Once given, you may revoke your authorization in writing at any time.
Your Rights Regarding Your Protected Health Information.
You have the following rights with respect to your protected health information:
*The right to request restrictions on certain uses and disclosures of your medical information.
*The right to receive communications from Company in a confidential manner.
*The right to inspect and copy your medical information.
*The right to request an amendment of your medical information.
*The right to receive an accounting of the disclosures of your medical information made by Company.
*The right to request a paper copy of this Notice of Privacy Practices for Protected Health Information.
*The right to complain to Company and/or to the United State Department of Health and Human Services if you believe
that the Company has violated your privacy rights.
To complain to Company, please contact the Company's Privacy Officer at
(866)960-9497 or email us at info@rxhelp4u.com.
This Privacy Notice was developed and is used by the Company as part of its HIPAA compliance efforts.
Notice is Effective January 1, 2009.
CANCELLATION POLICY
You may cancel the service any time after enrollment with a minimum of 14 days notice in writing prior to the next
billing cycle as banking systems require advance notice. For our patients' protection, we would never want to cancel
someone out of our program and stop processing their refills without written notification from the patient. Please
submit written cancellation notice including the patient's address, telephone, social security number (to verify we are
cancelling the correct person), reason for cancelling, and the patient's signature to your Personal Advocate.
IMPORTANT: Do not attempt to cancel by revoking charges to your account as you will be held responsible for fees
we incur and your service fees due prior to receipt of your written cancellation.
REFUND POLICY
Because we care, we would not want you to pay for our service if we cannot save you money. Assuming all your
provided information was complete and accurate, we will refund your money if you do not qualify for the PAP
programs that result in a savings for you. To request a refund submit all your denial letters from the pharmaceutical
companies involved within 120 days of enrolling in our program to your Personal Advocate.
IMPORTANT: Do not revoke charges to your account as you will be held responsible for fees we incur.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Rx HELP (herein referred to as Company) is dedicated to protecting your medical information. We are required by law
to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and
privacy practices with respect to protected health information.
Company is required by law to abide by the terms of this Notice.
We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health
information we maintain. If Company revises the terms of this Notice, it will post a revised notice at the Company and
will make paper copies of this Notice of Privacy Practice for Protected Health Information available upon request.
How Your Medical Information Will Be Used and Disclosed:
Company will use your medical information as part of rendering our prescription assistance services and functioning
as a health care advocate. For example, your medical information may be used by the health care professional
assisting you, by the business office to process your payment for the services rendered and by administrative
personnel reviewing the quality and appropriateness of the service you received.
Company may also use and/or disclose your information in accordance with federal and state laws for the following
purposes:
Company may contact you to provide appointment reminders or information about service alternatives or other
health-related benefits and services that may be of interest to you.
Company may use your personal and/or medical information to make referrals for other related services you may have
requested or may have been recommended to you.
Company may disclose medical information when required by the United States Department of Health and Human
Services as part of an investigation or determination of the Company's compliance with relevant laws.
Unless you object, Company may disclose your medical information to a Family member, Guardian, Power of
Attorney or Health Care Surrogate as related to the services being rendered if deemed necessary to complete
process for which services have been requested.
Company may disclose your medical information in the course of certain judicial or administrative proceedings as
required by law.
Company will not use or disclose your medical information for any other purpose without your written authorization.
Once given, you may revoke your authorization in writing at any time.
Your Rights Regarding Your Protected Health Information.
You have the following rights with respect to your protected health information:
*The right to request restrictions on certain uses and disclosures of your medical information.
*The right to receive communications from Company in a confidential manner.
*The right to inspect and copy your medical information.
*The right to request an amendment of your medical information.
*The right to receive an accounting of the disclosures of your medical information made by Company.
*The right to request a paper copy of this Notice of Privacy Practices for Protected Health Information.
*The right to complain to Company and/or to the United State Department of Health and Human Services if you believe
that the Company has violated your privacy rights.
To complain to Company, please contact the Company's Privacy Officer at
(866)960-9497 or email us at info@rxhelp4u.com.
This Privacy Notice was developed and is used by the Company as part of its HIPAA compliance efforts.
Notice is Effective January 1, 2009.
CANCELLATION POLICY
You may cancel the service any time after enrollment with a minimum of 14 days notice in writing prior to the next
billing cycle as banking systems require advance notice. For our patients' protection, we would never want to cancel
someone out of our program and stop processing their refills without written notification from the patient. Please
submit written cancellation notice including the patient's address, telephone, social security number (to verify we are
cancelling the correct person), reason for cancelling, and the patient's signature to your Personal Advocate.
IMPORTANT: Do not attempt to cancel by revoking charges to your account as you will be held responsible for fees
we incur and your service fees due prior to receipt of your written cancellation.
REFUND POLICY
Because we care, we would not want you to pay for our service if we cannot save you money. Assuming all your
provided information was complete and accurate, we will refund your money if you do not qualify for the PAP
programs that result in a savings for you. To request a refund submit all your denial letters from the pharmaceutical
companies involved within 120 days of enrolling in our program to your Personal Advocate.
IMPORTANT: Do not revoke charges to your account as you will be held responsible for fees we incur.