33-31-113. Confidentiality of medical information. (1) Any data or information pertaining to the diagnosis, treatment, or health of an enrollee or applicant obtained from the enrollee, applicant, or a provider by a health maintenance organization must be held in confidence and may not be disclosed to any person except:

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Terms Used In Montana Code 33-31-113

  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Enrollee: means a person:

    (a)who enrolls in or contracts with a health maintenance organization;

    (b)on whose behalf a contract is made with a health maintenance organization to receive health care services; or

    (c)on whose behalf the health maintenance organization contracts to receive health care services. See Montana Code 33-31-102

  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Health maintenance organization: means a person who provides or arranges for basic health care services to enrollees on a prepaid basis, either directly through provider employees or through contractual or other arrangements with a provider or a group of providers. See Montana Code 33-31-102
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Person: means :

    (a)an individual;

    (b)a group of individuals;

    (c)an insurer, as defined in 33-1-201;

    (d)a health service corporation, as defined in 33-30-101;

    (e)a corporation, partnership, facility, association, or trust; or

    (f)an institution of a governmental unit of any state licensed by that state to provide health care, including but not limited to a physician, hospital, hospital-related facility, or long-term care facility. See Montana Code 33-31-102

  • Provider: means a physician, hospital, hospital-related facility, long-term care facility, dentist, osteopath, chiropractor, optometrist, podiatrist, psychologist, licensed social worker, registered pharmacist, or advanced practice registered nurse, as specifically listed in 37-8-202, or registered nurse first assistant as defined by the board of nursing under Title 37, chapter 8, who treats any illness or injury within the scope and limitations of the provider's practice or any other person who is licensed or otherwise authorized in this state to furnish health care services. See Montana Code 33-31-102
  • Statute: A law passed by a legislature.

(a)to the extent that it may be necessary to carry out the purposes of this chapter;

(b)upon the express consent of the enrollee or applicant;

(c)pursuant to statute or court order for the production of evidence or the discovery thereof; or

(d)in the event of claim or litigation between the enrollee or applicant and the health maintenance organization wherein the data or information is pertinent.

(2)A health maintenance organization is entitled to claim the same statutory privileges against disclosure that the provider who furnished the information to the health maintenance organization is entitled to claim.