Preview of disclaimer and authorization for interoperability

Disclaimer

As you begin to use your chosen third-party application, you'll need to acknowledge that you understand that you are authorizing Blue Cross to disclose your personal information to the application you have selected.

We're required by law to share this disclaimer with you.

By clicking “I understand” below, you direct Blue Cross to disclose your personal information to an application that you have selected. By doing so, you acknowledge that:

• The application is not subject to HIPAA or other laws specifically designed to safeguard your privacy
• Blue Cross is not responsible for anything that happens to your personal information after it is disclosed to the application
• Some of the information to be disclosed was not created by Blue Cross and Blue Cross is not required to and does not verify the accuracy of the information before disclosing it to the application
• Blue Cross is not responsible for the accuracy of the information or whether the information is current
• Blue Cross is required to comply with your request to disclose your personal information to the application, even if the application fails to appropriately secure your personal information

TO THE MAXIMUM EXTENT PERMITTED BY LAW, BLUE CROSS WILL NOT BE LIABLE FOR ANY INCIDENTAL, INDIRECT, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, WHETHER INCURRED DIRECTLY OR INDIRECTLY, RESULTING FROM (A) DISCLOSURE OF YOUR PERSONAL INFORMATION IN ACCORDANCE WITH THIS REQUEST; OR (B) ANY UNAUTHORIZED ACCESS TO, OR USE OR RE-DISCLOSURE OF YOUR PERSONAL INFORMATION THAT TAKES PLACE AS A RESULT OF BLUE CROSS' DISCLOSURE. THESE LIMITATIONS APPLY TO ANY THEORY OF LIABILITY, WHETHER BASED ON CONTRACT, TORT (INCLUDING NEGLIGENCE), STATUTE, OR OTHERWISE, AND WHETHER BLUE CROSS HAS BEEN INFORMED OF THE POSSIBILITY OF ANY SUCH DAMAGE.

Authorization to disclose protected health information

As you begin to use your chosen third-party application, you'll need to agree that you are confirming your authorization for the disclosures of information, as described above.

You have asked Blue Cross to electronically disclose detailed information about your health history to a third party. We recommend that you read educational materials that we publish about such disclosures before agreeing to provide your personal information to a third party.

See educational information

By clicking the “I agree” button below after reading this, you authorize Blue Cross to disclose to an application that you have selected the following information, which may include your name, address, diagnoses, treatments performed on you amounts paid to providers, as well as other data: 

• Claims and encounter data related to your interactions with health care providers
• Clinical data that we collect in the process of providing case management, care coordination or other services to you

This includes information we have collected about you while you have been enrolled in Medicare Advantage or Medicaid since January 1, 2016, for as long as we maintain the information.

The information we will disclose may include information about treatment for Substance Use Disorders, mental health treatment, HIV status or other sensitive information. 

By clicking on the “I agree” button below after reading this, you acknowledge that the application named above is not subject to federal health information privacy laws such as HIPAA and any information the application receives will no longer be subject to such laws.  

This authorization is voluntary. It will remain in effect for one year unless revoked sooner. You understand that Blue Cross will not condition payment for health care, enrollment in a health plan or eligibility for benefits on this authorization. You may revoke this authorization by sending a request in writing to: 

Blue Cross and Blue Shield of Minnesota
P.O. Box 64560
St. Paul, MN 55164

When you revoke this authorization, the revocation will not affect any disclosure Blue Cross made in reliance on this authorization before your revocation.