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Individual Rights To exercise any of these rights, please call the customer service number on your ID card. Access : With limited exceptions , you have the right to review in person , or obtain copies of your PHI . We reserve the right to impose reasonable fees associated with this access request as allowed by law. Amendment : With limited exceptions , you have the right to request that we amend your PHI that we have on file . Disclosure Accounting : You have the right to request and receive a list of certain disclosures made of your PHI . If you request this list more than once in a 12-month period , we may charge you a reasonable , cost-based fee to respond to any additional request . Use/Disclosure Restriction : You have the right to request that we place certain additional restrictions on our use or disclosure of your PHI . We are not required to agree to a requested restriction . Confidential Communication : You have the right to request that we communicate with you in confidence about your PHI at an alternative address . To receive confidential communications at an alternative address , please ask for a PHI address when you call the customer service number located on your ID card . Provider Services and Confidential Communications : If you receive services from any health care providers , you are responsible for notifying those providers directly if you would like to request a PHI address from them . Privacy Notice : You may request a copy of our notice at any time . For more information about our privacy practices , or for additional copies of or questions about this notice , please contact us using the information listed at the end of this notice . Organizations Covered by this Notice This Notice applies to the privacy practices of the organizations listed below : Your group health plan sponsored by your employer and for which Blue Cross and Blue Shield of Florida , Health Options , Inc . or Florida Combined Life Insurance Company, Inc . provides claim administration and other services . Complaints If you are concerned that we may have violated your privacy rights , you may complain to us using the contact information listed at the end of this Notice . You also may submit a written complaint to the U . S . Department of Health and Human Services . We will provide you with the 14 HIPAA\BA Amend to ASO Agmt - fini August 12 , 2004