Patient Rights

Use the Authorization to Use or Disclose Protected Health Information Form (also known as an appointment of a representative) form when you want CEC to share your information over the telephone with your representative, such as a spouse, relative, or law firm.

Your information may include:

·       Claims

·       Claims adjudication information

·       Eligibility/benefit information

·       Provider information

Note: This form does not include release of your mental health/substance abuse/HIV claims and authorization information, or genetic information.

This form must be completed by the member (or authorized representative) and must include an expiration date. If no expiration date is specified, this authorization will expire 24 months from date of signature.

Requests take 7-10 business days from date of receipt to process. You will not be notified of approval. Denied forms will be returned to the member.

Send completed forms to:

CEC
ATTN: Privacy Office
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217
privacyoffice@cecvision.com

You have the right to be treated with consideration, dignity, respect and to have CEC network doctors:

• Provide you with complete information about your eyecare and any proposed procedures and alternatives regardless of cost or benefit coverage.
• Assure that you control decisions about your eyecare treatment.
• Provide 24-hour access for ocular emergencies.
• Maintain privacy and confidentiality regarding your care.
• Make available to you appropriate preventive health services.
• Give prompt and reasonable responses to questions and requests.
• Provide information regarding their services and qualifications.
• Provide you with CEC grievance procedures if there is dissatisfaction with services.
• Obtain your input regarding services and assist you with any problems.
   

Your responsibility is to remember to practice healthy living habits, follow preventive health and eyecare guidelines, and:

• Check the health care benefits and exclusions of your coverage.
• Establish and maintain a relationship with your primary eyecare provider.
• Give your eyecare providers complete and accurate information needed in order to care for you.
• Notify your eyecare provider if you are going to be late or need to reschedule an appointment.
• Know the cost (co-payment, deductible, coinsurance) of your care.
• Carry out the treatment plan agreed upon by you and your eyecare provider or primary care physician.
• Know how to access urgent, emergency and out-of-area medical eyecare services.

Requests for accounting of disclosures must be submitted in writing and include the member’s name, date of birth, member ID, address, telephone number, email (if available), and the time frame for the accounting. If a request is submitted on behalf of a member, an authorization to disclose form or other legal documentation, such as a power of attorney or custody documents, must be submitted with the request.

CEC provides an accounting for protected health information disclosed in the six years prior to the date on which the accounting is requested (electronic health records disclosed three years prior to the date on which the accounting is requested).

CEC doesn’t provide an accounting for disclosures:

• to carry out treatment, payment, and healthcare operations
• to individuals of protected health information about them
• incident to a use or disclosure otherwise permitted or required
• pursuant to an authorization
• for the CEC member directory or to persons involved in the individual's care or other notification purposes
• for national security or intelligence purposes
• to correctional institutions or law enforcement officials
• as part of a limited data set
   

CEC will respond to your request no later than 10 business days after date of receipt.

Submit your requests to:

CEC
Attn: Compliance
 4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217
privacyoffice@cecvision.com

If you feel your health records are incomplete or inaccurate, you have the right to request an amendment or correction to your protected health information. CEC will respond to all requests to amend. However, CEC doesn’t create patient medical or billing records and generally can’t grant an amendment. In most cases, CEC will direct you to submit the request to the provider or facility that rendered care.

Requests for amendment must be submitted in writing and you’ll need to provide a reason to support the amendment. Requests can be submitted to:

CEC
Attn: Compliance
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217

privacyoffice@cecvision.com

CEC will respond to your request no later than 10 business days after date of receipt.

Note: A request to correct member profile errors, update demographic information, or correct billing or processing errors isn’t considered a request for amendment.

To address these types of requests: call 888-254-4290 to speak with Member Services:

Monday - Friday 8 a.m. to 6 p.m., EST

Saturday 10 a.m. to 3 p.m., EST

Closed Thanksgiving Day and Christmas Day

Request for Records Form

Use the Request for Records Form (also known as a request to access protected health information) to request copies of member records maintained by CEC.

Records maintained by CEC include:

• Claims
• Complaints/appeals you have filed
• Authorization for Use and Disclosure forms you have submitted

Note: This form does not include release of mental health/substance abuse/HIV claims and authorization information, or genetic information.

Section 3 (dates of coverage/service) must be completed. Forms without dates of service will be returned.

This form must be completed by the member (or legal representative).

Send completed forms to:

CEC
Attn: Privacy Requests
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217
privacyoffice@cecvision.com

Create an account on cecvision.com for instant access to your personal benefit information.

Call CEC Member Services at 888-254-4290 to request eligibility and benefit information or an out-of-pocket expense summary.

Hours of Operations:
Monday - Friday 8 a.m. to 6 p.m., EST
Saturday 10 a.m. to 3 p.m., EST

If you could be at risk of harm, harassment, or abuse when your health information is shared, you have the right to request CEC restrict how protected health information (PHI) about you is used or disclosed.

CEC implements restrictions of PHI through its Protected Member Confidentiality Program. CEC members may request a restriction by completing the Request for Restriction of Use and Disclosure of Protected Health Information and Confidential Communications Form.  

CEC will respond to your request no later than 10 business days after date of receipt.

Submit your requests to:

CEC
Attn: Regulatory Compliance
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217

privacyoffice@cecvision.com

If you could be at risk of harm, harassment, or abuse when your health information is shared, you have the right to request CEC send your protected health information (PHI) to you at an alternative address.

CEC implements alternative addresses through its Protected Member Confidentiality Program. CEC members may request an alternative address be used when sending PHI by completing the Request for Restriction of Use and Disclosure of Protected Health Information and Confidential Communications form available on cecvision.com.

CEC will make every effort to send all claim and billing information containing PHI related specifically to you, including dates of services received and the name of the provider of services, to the alternative address you provide.

CEC will respond to your request no later than 10 business days after date of receipt.

Submit your requests to:

CEC
Attn: Compliance
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217
privacyoffice@cecvision.com

Note: This form is for Medicare & Medicaid recipients only. All other members are to complete the Authorization to Use of Disclose Protected Health Information Form or submit a power of attorney. For instructions on submitting the Authorization to Use or Disclose Protected Health Information Form or power of attorney, please visit the Patient Rights page on www.cecvision.com.

You can name another person to act for you as your "representative" to:

• Ask for a coverage decision.
• File a grievance.
• Make an appeal on your behalf.

Your designated representative will have the same rights as you do in asking for a coverage decision, filing a grievance, or making an appeal. This person can be a relative, friend, doctor, or anyone else whom you trust to act on your behalf. If you want to appoint someone to act for you, then both you and that person must sign and date a statement that gives the person legal permission to act as your appointed representative. We must receive this written statement before initiating any coverage decisions or appeal requests that your representative makes on your behalf.

To appoint a friend, relative, or other person to be your representative, you have two options:

Option 1

Complete an "Appointment of Representative" form. You can download and print this form from our website or call CEC Member Services and ask for the "CMS 1696" form to be emailed or mailed to you. You can also get the form on the Centers for Medicare & Medicaid Service website. The form gives the person permission to act for you. You must give us a copy of the signed form. To submit this form with an electronic signature, the submitter must be registered and logged into www.cecvision.com.

CMS 1696

CMS 1696 Spanish

CMS 1696 Large Print

Electronic Signature Submission: To submit this form with electronic signature, you must have Adobe Acrobat Pro X. To submit this form with an electronic signature, complete the form, select Tools > Forms > Distribute and enter privacyoffice@cecvision.com in the address field, and enter CMS1696 in the subject field.

Option 2

Send us an equivalent written notice. You may write your own equivalent notice as long as it includes all of the required information below. If it does not include all of the information below, you will not be able to appoint a representative. A notice is an "equivalent written notice" if it:

• Includes the name, address, and telephone number of member.
• Includes the member’s HICN (or Medicare Identifier [ID] Number).
• Includes the name, address, and telephone number of the individual being appointed.
• Contains a statement that the member is authorizing the representative to act on his or her behalf for the claim(s) at issue, and a statement authorizing disclosure of individually identifying information to the representative.
• Is signed and dated by the member making the appointment.
• Is signed and dated by the individual being appointed as representative and is accompanied by a statement that the individual accepts the appointment.

A signed form or notice must be included with each request for a coverage decision, grievance, or appeal made on your behalf. If you need assistance in naming your appointed representative, please call Member Services. You can mail or email the completed form or an equivalent written notice to:

CEC
Attn: Privacy Requests
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217
privacyoffice@cecvision.com

You have the right to appeal if:

• You do not agree with CEC's decision about your health care.
• CEC will not approve or give you care you feel it should cover.
• CEC is stopping care you feel you still need.

CEC normally has 30 days to process your appeal. In some cases, you have a right to a faster, 24-hour appeal. You can get a fast appeal if your health or ability to function could be seriously harmed by waiting 30 days for a standard appeal. If you ask for a fast appeal, CEC will decide if you get a 24-hour/fast appeal. If not, your appeal will be processed in 30 days. If any doctor asks CEC to give you a fast appeal, or supports your request for a fast appeal, it must be given to you.

If you want to file an appeal which will be processed within 30 days, do the following:

File the request in writing with CEC at the following address:
 

CEC
Attn: Appeals Department
4944 Parkway Plaza Blvd
Suite 200
Charlotte, NC 28217

Even though you may file your requests with CEC, CEC may transfer your request to the appropriate agency for processing. Your appeal request will be processed within 30 days from the date your request is received.

If you want to file a fast appeal, which will be processed within 24 hours, do the following:

• File an oral or written request for a 24-hour appeal. Specifically, state that "I am requesting an: expedited appeal, fast appeal or 24-hour appeal." Or "I believe that my health could be seriously harmed by waiting 30 days for a normal appeal."
• To file a request orally, call 888-254-4290. CEC will document the oral request in writing.

Help with your appeal:

If you decide to appeal and want help with your appeal, you may have your doctor, a friend, lawyer, or someone else help you. There are several groups that can help you. If you are covered by Medicare, you may contact the Medicare Rights Center toll free at 888.HMO.9050. You may also contact the National Aging Information Center at 202.619.7501 to request the phone number of your local Area Agency on Aging or Health Insurance Counseling and Assistance Program (HICAP).