Aetna considers personal information to be confidential
and has policies and procedures in place to protect it against
unlawful use and disclosure. By “personal information,” we mean
information that relates to a member’s physical or mental health or
condition, the provision of health care to the member, or payment
for the provision of health care to the member. Personal
information does not include publicly available information or
information that is available or reported in a summarized or
aggregate fashion but does not identify the member.
When necessary or appropriate for your care or treatment,
the operation of our health plans, or other related activities, we
use personal information internally, share it with our affiliates,
and disclose it to health care providers (doctors, dentists,
pharmacies, hospitals and other caregivers), payors (health care
provider organizations, employers who sponsor self-funded health
plans or who share responsibility for the payment of benefits, and
others who may be financially responsible for payment for the
services or benefits you receive under your plan), other insurers,
third party administrators, vendors, consultants, government
authorities, and their respective agents. These parties are
required to keep personal information confidential as provided by
applicable law. Participating network providers are also required
to give you access to your medical records within a reasonable
amount of time after you make a request.
Some of the ways in which personal information is used
include claims payment; utilization review and management; medical
necessity reviews; coordination of care and benefits; preventive
health, early detection, and disease and case management; quality
assessment and improvement activities; auditing and anti-fraud
activities; performance measurement and outcomes assessment; health
claims analysis and reporting; health services research; data and
information systems management; compliance with legal and
regulatory requirements; formulary management; litigation
proceedings; transfer of policies or contracts to and from other
insurers, HMOs and third party administrators; underwriting
activities; and due diligence activities in connection with the
purchase or sale of some or all of our business. We consider these
activities key for the operation of our health plans. To the extent
permitted by law, we use and disclose personal information as
provided above without member consent. However, we recognize that
many members do not want to receive unsolicited marketing materials
unrelated to their health benefits. We do not disclose personal
information for these marketing purposes unless the member
consents. We also have policies addressing circumstances in which
members are unable to give consent.