Who We AreResilience. Recovery. Wellness.
Health Affiliates Maine (HAM) is a statewide mental health and substance abuse agency founded to help reduce the stigma associated with mental illness and to support mental health professionals.
With our network of clinicians, case managers, and Behavioral Health Home teams, we provide outpatient therapy, substance abuse counseling, case management, and psychiatric treatment to people of all ages. For individuals, we work to normalize the reality that all of us struggle at some point with mental health or substance use issues.
For mental health professionals, we work as an advocate, insurance biller, and red tape navigator, so they can focus on what matters: helping Mainers build resilience and reach their potential.
Health Affiliates Maine believes that we all struggle at times with mental health or substance use issues. Our mission is to empower and support Maine’s mental health professionals so that they may help individuals to enhance their own quality of life. By removing barriers that stand between Mainers and their access to mental health services, we build healthier communities.
By recognizing that all people are affected by mental health and substance use issues, we will reduce the stigma associated with accessing such services, thus increasing the opportunity for all people to participate in their own journey to wellness.
In September 2010, Andrea Krebs, LCSW, and a passionate group of like-minded women decided to create a new kind of mental health agency. Tired of mandated quotas and bureaucracy, their aim was to support the work of clinicians by building a flexible, collaborative alternative, thereby allowing mental health providers to focus on their most important work: their clients.
The agency has since grown to be a highly respected licensed Mental Health, Substance Abuse, and Psychiatric Assessment & Treatment agency, with over 300 affiliate clinicians and 80 case managers serving clients in every county in Maine.
In 2013, Health Affiliates Maine was named by Inc. Magazine as one of the fastest growing small businesses, one of only thirteen named in Maine.
Andrea Krebs, Executive Director, shares her philosophy:
“I believe that we are all on a continuum of mental health; there are times in our lives when we are healthy, and times when we are less healthy. The ‘journey’ indicates that we have ups and downs, obstacles and leaps in our journey to wellness, just as our clients do. In our work with clients, our journey is impacted by theirs, and their journey is impacted by ours, and that is why it is a shared experience. It works because when clinicians and case managers are supported in striving for excellence and ethical practice, the people who need help benefit.”
-Andrea Krebs, Executive Director
Staff DirectoryMeet our dynamic team!
Andrea Krebs, LCSW Executive Director
207-333-3278 Ext. 204 firstname.lastname@example.org
A therapist, director, leader, and woman with tremendous drive, Andrea Krebs not only works every day to reduce the stigma our society has surrounding mental health and substance abuse issues, but she also endeavors to support fellow therapists who should be allowed to focus on their critically important work: helping Mainers build resilience, improve quality of life, and reach their potential.
Andrea knew a mental health and substance abuse agency should and could function differently—supporting the important work of the clinician in order to ultimately help the client. Tired of other agencies’ mandated billing quotas and overwhelming bureaucracy that only served to drag therapists down, she founded Health Affiliates Maine (HAM)—a flexible, nimble, and compassionate alternative whose mission is to truly support clinicians so they can support their clients.
A graduate of the University of Maryland in Baltimore with a master’s in social work, Andrea has worked with children, adolescents, families, and couples in outpatient clinics, public schools, and in private practice. She has been in senior management of community mental health organizations since 2006.
Andrea believes that mental health and substance abuse issues impact all people’s lives either personally or through the people they know and love. With outpatient counseling, case management, and psychiatric treatment, Health Affiliates Maine guides people toward recovery at their own pace, with ongoing compassion, respect, and support. Through this mission, Andrea and the Health Affiliates Maine team work to reduce the stigma associated with accessing treatment so as to encourage all people to fully participate in their own “Journey to Wellness.”
Nina Bartlett Director of Operations
207-333-3278 Ext. 253 Nina.Bartlett@healthaffiliatesmaine.com
An experienced operations manager, Nina has managed various office environments throughout her career—with both local and national companies. In her role as Director of Operations at HAM, Nina oversees all operations, which include billing, quality assurance, medical records, information technology, accounting, credentialing and referrals. She also manages the facilities for all of our satellite offices located throughout the state.
A graduate of Lewiston High School and student at UMA, Nina continues her professional development through life experience and educational units—both of which have fueled her talents for organizational development, leadership, and strategic planning.
Melissa Bowker-Kinley, MD, PhD Medical Director
207-333-3278 Ext. 204 email@example.com
As Health Affiliates Maine’s medical director, Dr. Bowker-Kinley oversees our Psychiatric Assessment and Treatment services and provides psychiatric care to patients in the Lewiston, Auburn, and Portland areas.
A graduate of Indiana University School of Medicine, Dr. Bowker-Kinley completed her psychiatry residency at New York State Psychiatric Institute while simultaneously pursuing a public psychiatry fellowship at Columbia University. Dr. Bowker-Kinley transitioned to Maine for a fellowship in child and adolescent psychiatry at Maine Medical Center. Her deep professional experience includes inpatient child and adolescent psychiatry, assessment and diagnosis of children, adolescents, and adults, pharmacological treatment of youth and adults, and psychotherapy with children, adolescents, and young adults.
In addition to her clinical experience, Dr. Bowker-Kinley served as a faculty member in the Maine Medical Center Department of Child and Adolescent Psychiatry, providing clinical supervision to general psychiatry residents and child psychiatry fellows and lecturing on topics such as adolescent development, treatment of eating disorders, treatment of psychosis, and management of non-suicidal self-injury.
Kate Marble, LCSW Case Management Program Director
207-333-3278 Ext. 221 firstname.lastname@example.org
As Case Management Program Director, Kate oversees utilization review and our case management program. In her role and as a social worker herself, Kate emphasizes self-care for case managers so they can provide the highest quality care for the clients they serve.
A graduate of the University of New England with a master’s in social work, Kate began her career at Healthy Community Coalition. There she was recognized for her work on programs such as Tobacco-Free Franklin Families, an initiative to increase providers’ capability to help pregnant and parenting women quit tobacco. She was also instrumentally involved in the Domestic Violence Response Project, an initiative to improve the community response to domestic violence.
Inspired by this work, Kate pursued social work, working in community mental health as an outpatient therapist and program coordinator for a licensed mental health agency. Kate holds a bachelor’s degree in health education from the University of Presque Isle and a master’s degree in social work from the University of New England.
Kristy Gelinas, LCSW, LADC, CCSOutpatient Therapy Program Director
207-333-3278 Ext. 250 email@example.com
As the Outpatient Therapy Program Director, Kristy oversees affiliate supervisory support for the outpatient therapy program and is dedicated to assisting affiliates as they develop their private practices. She commits her efforts to streamlining tasks outside of clinical work so that the affiliate focus can remain devoted to client care and less on the administrative aspects involved with direct service.
A graduate of the University of Maine at Orono with a master’s in social work, Kristy started her career within the St. Mary’s Health System as a clinician in a residential program for adolescents that experience emotional and behavioral challenges. She also engaged in various direct service roles within Community Clinical Services, including integrated clinical work within a primary care setting, school-based health counseling services for adolescents and their families, and outpatient counseling. Prior to her arrival at Health Affiliates Maine, she served as Practice Manager of Outpatient Counseling and School Based Health – Behavioral Services.
Kristy appreciates the person-centered perspective and believes in promoting equality between client and clinician. These viewpoints drive both her clinical and administrative approach. For Kristy, it’s the client’s own experiences and beliefs that are the most valid in determining successful solutions. She always creates a positive, interactive experience within a supportive and non-judgmental environment. This style of communication is also transferable to the way she approaches relationships with affiliates.
Contact UsWe are here to help you begin your journey to wellness!
Andrea Krebs, LCSW
For all deliveries
Health Affiliates Maine
306 Rodman Rd, Auburn, ME 04210
Health Affiliates Maine
PO Box 1150
Auburn Maine 04211
Toll Free: 1-877-888-4304
By appointment only. Deliveries not accepted.
85 Stone Street
66 Main Street
311 Darling Ave.
284 Main St. Suite 360
Get In Touch
Send us a message by completing the form.
Contact by Department
Kristy Gelinas, LCSW, LADC, CSS Outpatient Therapy Program Director
firstname.lastname@example.org Ext. 250
Cindy Mailhot, LCSW Assistant Director of Outpatient Therapy
email@example.com Ext. 233
Lindsay McKeen, LCSW, CCS Outpatient Therapy Supervisor
firstname.lastname@example.org Ext. 243
Jay Burrows, LCPC, LADC, CCS Outpatient Therapy Supervisor
email@example.com Ext. 275
Jenny Bouldry, LCSW Outpatient Therapy Supervisor
firstname.lastname@example.org Ext. 234
Jessica St. Pierre Clinical Support Specialist
email@example.com Ext. 216
Department Support – firstname.lastname@example.org
Janet Verrill, LSW, MHRT/C Assistant Director of Program Integrity
email@example.com Ext. 230
Lisa Zaleski, MHRT/C Program Integrity Team Leader
firstname.lastname@example.org Ext. 228
Brittany Kell Program Integrity Advisor
email@example.com Ext. 245
Deborah Spaulding, BS, MHRT/C Program Integrity Specialist
firstname.lastname@example.org Ext. 249
Tina Williamson, MHRT/C Program Integrity Specialist
email@example.com Ext. 236
Haley Hollis, MHRT/C Program Integrity Specialist
firstname.lastname@example.org Ext. 251
Laurie Hudson Program Integrity Support
email@example.com Ext. 311
Cassandra Damon Program Integrity Support
firstname.lastname@example.org Ext. 258
Tobie Madore Program Integrity Support
email@example.com Ext. 210
Audrey Coulombe Program Integrity Support
firstname.lastname@example.org Ext. 241
Department Support – email@example.com
Michelle Elwell, SHRM-CP Assistant Director of Human Resources
Melwell@healthaffiliatesmaine.com Ext. 227
Nancy Gatchell Human Resources Team Leader
Ngatchell@healthaffiliatesmaine.com Ext. 215
Mary Gagnon, LMFT Training and Clinical Development Specialist
firstname.lastname@example.org Ext. 222
Gina Blanchard Payroll and Benefits Administrator
Gina.Blanchard@healthaffiliatesmaine.com Ext. 273
Cadyn Wilson Human Resources Assistant
email@example.com Ext. 232
Roxanne Chabot Operations Support Supervisor
Roxanne.firstname.lastname@example.org Ext. 224
Amber Mcquaide New Client Coordinator & Credentialing Representative
email@example.com Ext. 226
Tanya Chickering Receptionist
firstname.lastname@example.org Ext. 289
Morgan Sewell Operations Support Tech
email@example.com Ext. 289
Case Management and Behavioral Health Home
Kate Marble, LCSW Case Management Program Director
firstname.lastname@example.org Ext. 221
Michelle Pilotte, LCSW Assistant Director
email@example.com Ext. 231
Maria Tripp, LMSW-CC Case Management Supervisor
firstname.lastname@example.org Ext. 276
Marylena Chaisson, LCPC Case Management Supervisor
email@example.com Ext. 219
Kelly Bruneau, LCPC Case Management Supervisor
firstname.lastname@example.org Ext. 252
Stephanie Thompson, LCSW Case Management Supervisor and BHH Clinical Team Lead
email@example.com Ext. 361
Katie Talon, LCSW Case Management Clinical Coordinator
firstname.lastname@example.org Ext. 223
Deborah Mason BHH Nurse Care Manager
email@example.com Ext. 309
Brenday Choiniere Family Peer Support Specialist
firstname.lastname@example.org Ext. 306
Julie Potter Certified Intentional Peer Support Specialist
email@example.com Ext. 214
Department Support – firstname.lastname@example.org or email@example.com
Tammy Belanger Billing Supervisor
firstname.lastname@example.org Ext. 213
Michelle St. Pierre MaineCare Billing Representative
email@example.com Ext. 235
Sheila Daft-Fuentes MaineCare Billing Representative
firstname.lastname@example.org Ext. 237
Tina Walker Commercial Billing Representative
email@example.com Ext. 362
Melanie Arnold Commercial Billing Representative
Melanie.Arnold@healthaffiliatesmaine.com Ext. 271
Kian Beaulieu Commercial Billing Representative
firstname.lastname@example.org Ext. TBD
Department Support – email@example.com
Alan Holbrook, LSW, MHRT/C Referral Supervisor
firstname.lastname@example.org Ext. 259
Johanna Dumas Referral Coordinator
email@example.com Ext. 279
Information Technology (IT) IT Helpdesk
Lee Darling Accounting Manager
Lee.Darling@HealthAffiliatesMaine.com Ext. 207
Susan Fish Accounting Assistant
Sfish@HealthAffiliatesMaine.com Ext. 225
Notice of Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE BE ADVISED THAT ALL MENTAL HEALTH AND SUBSTANCE ABUSE INFORMATION ABOUT YOU REQUIRES A SPECIFIC WRITTEN AUTHORIZATION SIGNED BY YOU PRIOR TO ITS RELEASE. PLEASE REVIEW THIS DOCUMENT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Health Affiliates Maine, LLC (the “Company”) and your legal rights regarding your protected health information held by the Company under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
(1) your past, present, or future physical or mental health or condition;
(2) the provision of health care to you; or
(3) the past, present, or future payment for the provision of health care to you.
Information gathered by voluntary user submission
Health Affiliates Maine (HAM) collects the name, postal address, and email address of those users who contact us through our website. This information may be collected and used for marketing purposes. However, any information collected from the Health Affiliates Maine website will not be shared or sold to any outside individuals or companies and is reserved solely for the use of Health Affiliates Maine.
Information gathered by our web server
For each visitor to the Health Affiliates Maine website, our web server recognizes the consumer’s domain name, the pages or areas of the site that are visited, and the link followed to gain access to the HAM website. Our web server does not collect the email address of individual users. We use this information to assess user trends and interest in various areas of the HAM website and for site evaluation and development.
This Notice is effective March 21, 2014; Revisions made November 5, 2015; December 9, 2016; May 14, 2018; September 23, 2019.
We are required by law to:
- maintain the privacy of your protected health information;
- provide you with certain rights with respect to your protected health information;
- provide you with a copy of this Notice of our legal duties and privacy practices with respect to your protected health information; and
- follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices by mailing a copy to your last known address on file and by posting the revised Notice to our web-site.
How We May Use and Disclose Your Protected Health Information
Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment. We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about your medical condition to your primary care physician in order to coordinate your treatment services.
For Payment. We may use or disclose your protected health information to facilitate payment for the treatment and services you receive from the Company, or to coordinate insurance reimbursement. Likewise, we may share your protected health information with another entity to assist with the processing of payments.
For Health Care Operations. We may use and disclose your protected health information for other Company operations. These uses and disclosures are necessary to Company operations. For example, we may use medical information in connection with conducting quality assessment and improvement activities; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; organizational planning and development such as cost management; and business management and general Company administrative activities.
Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to process claims for health services rendered or to provide support services, such as utilization management or records destruction, but only after the Business Associate enters into a Business Associate contract with us.
As Required by Law. We will disclose your protected health information when required to do so by federal, state, or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.
In addition to the above, the following categories describe other possible ways that we may use and disclose your protected health information without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your protected health information after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your protected health information as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your protected health information for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your protected health information for public health activities. These activities generally include the following:
- to prevent or control disease, injury, or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. If requested by a law enforcement official to disclose your protected health information that is of a sensitive nature, such as mental health, substance abuse or HIV information, we will take all reasonable steps available under the law to avoid disclosure of such sensitive information. If asked by a law-enforcement official to disclose other protected health information of a less sensitive nature, we will disclose such information when authorized by law, including-
- in response to a court order, subpoena, warrant, summons, or similar process;
- to identify or locate a suspect, fugitive, material witness, or missing person;
- about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
- about a death that we believe may be the result of criminal conduct; and
- about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
National Security and Intelligence Activities. We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your protected health information to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your protected health information to researchers when:
(1) the individual identifiers have been removed; or
(2) when an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information, and approves the research.
The following is a description of disclosures of your protected health information we are required to make.
Government Audits. We are required to disclose your protected health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your protected health information that contains medical records, billing records, and any other records used to make decisions regarding your health care treatment. We are also required, when requested, to provide you with an accounting of most disclosures of your protected health information if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the protected health information was not disclosed pursuant to your individual authorization.
Personal Representatives. We will disclose your protected health information to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:
(1) you have been, or may be, subjected to domestic violence, abuse, or neglect by such person; or
(2) treating such person as your personal representative could endanger you; and
(3) in the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to you. If you have requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Authorizations. Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your protected health information for marketing; and we will not sell your protected health information, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
You have the following rights with respect to your protected health information:
Right to Inspect and Copy. You have the right to inspect and copy certain protected health information that may be used to make decisions about your treatment. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.
To inspect and copy your protected health information, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to Health Affiliates Maine.
Your records will be maintained by Health Affiliates Maine for six (6) years after discharge from services, or six (6) years after the 18th birthday for discharges from children’s services. A copy of your record can be requested at any time while it is being maintained. After the maintenance period, records will be shredded and no longer available.
Right to Amend. If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the Company.
To request an amendment, your request must be made in writing and provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- is not part of the medical information kept by the Company;
- was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the information that you would be permitted to inspect and copy; or
- is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your protected health information. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on your protected health information that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your protected health information that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. However, if you request a restriction and the personal health information you asked us to restrict is needed to provide you with emergency treatment, we may use that information or disclose that information to a health care provider in order to provide you with emergency treatment.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
To request restrictions, you must make your request in writing and include (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured protected health information.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www.healthaffiliatesmaine.com
To obtain a paper copy of this notice, contact our Privacy Officer, at (877) 888-4304.
If you believe that your privacy rights have been violated, you may file a complaint with the Company or with the Office for Civil Rights of the United States Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
To exercise any of your rights and/or file a complaint with Health Affiliates Maine, please contact our Privacy Officer, Health Affiliates Maine, PO Box 1150, Auburn Maine 04211 (phone: (877) 888-4304).