Services for Members

• Member Services
• Gateway Health Plan^SM Notice of Privacy Practices
• Hearing and Sight Problems
• Non-English Speaking Members
• Gateway Health Plan^SM ID Card

Member Services

The Gateway Health Plan^SM Member Services Department can help answer your questions. You may want to ask about a covered service, or you may need to talk to someone about a problem. Member Services can help you find a doctor and tell you about your doctor’s training. 

You can call Member Services 24 hours a day, 7 days a week. The phone number is 1-800-392-1147. The call is free, and Member Services would like to hear your ideas on making Gateway Health Plan^SM better. You may also visit Gateway’s website at www.gatewayhealthplan.com.

THIS NOTICE DESCRIBES HOW MEDICAL AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Gateway Health Plan^SM (“Gateway”) is required to protect the privacy of your personal medical and non-public personal information. Also, Gateway is required to give you this notice about how Gateway uses or gives out (“discloses”) medical and personal (“non-public”) information held by Gateway.

Gateway will use and give your medical information:

• To you or someone who acts for you (your personal representative)
• To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected, and
• When required by law.
• To meet your medical needs, to pay for your healthcare and to operate the Gateway benefit program, for example:
• To give information to help the doctors or other healthcare providers who care for you.
• To make sure you and other Gateway members get quality health care, to provide member services to you, or to resolve any complaints you have.
• To pay or deny your claims or to share payments and payment information with your other insurer(s).

Gateway may also use or give your medical information:

• To state and federal agencies that have the legal right to receive such data,
• For public health activities (such as reporting disease outbreaks),
• For government health care oversight activities (such as fraud investigations),
• For judicial and administrative proceedings (such as in response to a court order),
• For law enforcement purposes (such as providing limited information to locate a missing person),
• For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability),
• To avoid a serious and likely threat to health or safety,
• To contact you about new or changed benefits,
• To contact you for appointment reminders or for disease management programs and alternative treatments that may interest you, and
• To create a collection of information that can no longer be traced back to you.

Gateway must have your written permission (an “authorization”) to use or give out your medical information for any purpose that is not listed in this notice. You may take back (“revoke”) your written permission at any time, except if Gateway already took action based on your permission.

You have the right to:

• Ask for your medical information by writing to Gateway or by calling Gateway to request a form for this purpose.
• Ask Gateway to change your medical information if you can show that it is wrong or that information is missing by writing to Gateway or by calling Gateway to request a form for this purpose. If Gateway disagrees, you may have a statement of your disagreement added to your personal medical information.
• Get a list of who received your medical information within a six-year period by writing to Gateway or by calling Gateway to request a form for this purpose.  You must tell Gateway the dates for which you are requesting the list. The list will not cover information given out before April 14, 2003, information that was given to you or your personal representative, or information given for healthcare payments, for Gateway operations or for law enforcement needs.
• Ask Gateway to communicate with you in a different manner or at a different place (for example, by sending material to a P.O. Box instead of your home address), by writing to Gateway or by calling Gateway to request a form for this purpose. Gateway must have written reason(s) for your request(s) and may not be able to honor your request.
• Ask Gateway to limit the way your personal medical information is used or given to others, by writing to Gateway or by calling Gateway to request a form for this purpose. Please note that Gateway may not be able to do what you request.
• Call or write to Gateway to ask for a separate paper copy or e-mail copy of this Notice.

What is the non-public information that Gateway Health Plan^SM collects about you?

• It is personal information but is non-medical, for example, the information you completed on your enrollment application that identifies who you are and how you can be contacted.
• It is information collected for a request for services by you or your doctor.
• Also, it is information collected to answer a question or concern from you.

• Gateway does not give out your non-public information, except if required or permitted by law. 
• Gateway does not give out your non-public information to anyone unrelated to providing your care under the health plan unless you or your representative give permission

• Gateway does not make your non-public information available to anyone other than those necessary to provide medical or health plan services to you.
• You have the right to give or withhold permission for other uses or disclosures of this information, except as required by law.

If you believe Gateway has violated your privacy rights as stated in this notice, you may file a complaint at the following address:

Privacy Officer
Gateway Health Plan^SM
Regulatory, Compliance and Legal Affairs
600 Grant Street, 41st Floor
Pittsburgh, PA 15219

Filing a complaint will not affect your benefits. You may also file a complaint with the Secretary of the Department of Health and Human Services. For more information on filing a complaint or your rights stated in this notice, you may call Gateway’s Member Services Department at 1-800-392-1147.

Gateway is required to follow the terms in this privacy notice. Gateway has the right to change the way your medical information is used and given out. If Gateway makes any changes, you will get a notice by mail within sixty (60) days of the change.

These privacy practices went into effect April 14, 2003.

Some members with hearing problems use a TTY/TDD (Telecommunication Device for the Deaf) service to make phone calls. You can still talk to Member Services by calling the AT&T TDD Service at 1-800-654-5988 and asking to be transferred to Gateway Health Plan^SM Member Services at 1-800-392-1147.

Gateway Health Plan^SM offers the Member Handbook and other Gateway information in large print, Braille, on cassette tape, or computer diskette at no cost to the member.  Please call Member Services at 1-800-392-1147 to ask for these other formats.

If you do not speak English, call Member Services at 1-800-392-1147, and an interpreter will be provided. Please also call if you need your Gateway information translated.

SPANISH:             LLAME A SERVICIOS PARA MIEMBROS, AL TELEFONO

800-392-1147 Y SE LE FACILITARA UN INTERPRETE Y SI NECESITA QUE LE TRADUZCAN SU INFORMACION GATEWAY, LLAMENOS AL MISMO NUMERO.

CROATIAN:             Ako Vi ne govorite engleski, nazovite Usluzne Clanove

na 1-800-392-1147, i Vi cete imati tumaca.  Molimo Vas takode da nazovete ako Vase Gateway informacije trebaju biti prevedene.

RUSSIAN:

VIETNAMESE: Neu khong noi duoc tieng Anh, xin goi Dich Vu Hoi

Vien tai so 1-800-392-1147, de co mot thong dich vien giup do.  Quy vi cung nen goi cho    chung toi neu can dich cac thong tin ve Gateway cua minh.

Gateway Health Plan^SM members will receive a green plastic (ID) identification cards for every member of the family in Gateway Health Plan^SM.

You can start using your Gateway ID card on the “effective” date that is printed on the upper left hand corner of your card. The card is good for as long as you stay on Medical Assistance, and remain a member of Gateway Health Plan^SM. Your Gateway card does not replace your ACCESS card from the Department of Public Welfare.  Keep both cards!

You should keep your Gateway ID card and your ACCESS card with you at all times. Show both cards every time you go to the doctor or use any Gateway Health Plan^SM service.  Use your ACCESS Card for MA services that are not the responsibility of Gateway such as WIC, Medical Assistance Transportation Program (MATP), Mental Health, and Drug and Alcohol services. If your Gateway ID card is lost or stolen, call Member Services at 1-800-392-1147. If your ACCESS card is lost or stolen, call your caseworker at your local County Assistance office.