ZERO360: Comprehensive Patient Support Case Management Disclaimer

Please read this disclaimer carefully. It explains details about ZERO360: Comprehensive Support (ZERO360) Case Management. This program is administered by the Patient Advocate Foundation (PAF) in partnership with ZERO Prostate Cancer (ZERO):

1. Case Management services. This is what ZERO and PAF can do to help you resolve certain issues related to a serious health condition.
2. Program requirements. These are the rules that say who can get help from ZERO or PAF Case Management. 
3. Patient privacy. This describes how ZERO and PAF protects the personal information you share with us.  

Key points about ZERO360 Case Management

• ZERO360 Case Management services include helping you get prescribed medical treatment and helping you find ways to pay for treatment and living expenses.
• To get ZERO360 Case Management services, you must have been diagnosed with prostate cancer.  
• To help you with support and services, ZERO360 case managers ask you for personal information about your health condition and treatment. You share this information voluntarily. ZERO and PAF uses the information only with your permission.

For more information

• About ZERO360 Case Management: Call 844-244-1309.
• About PAF’s Patient Privacy Policy: Visit https://www.patientadvocate.org/privacy-policy/.

1. Case Management services

ZERO360 Case Management provides free, one-on-one support to patients, families and caregivers to help you manage challenges related to a prostate cancer diagnosis. Our case managers can help you sign up for programs and services offered by organizations like charities and government agencies that can help you with:

Access to care. This means getting medical care and treatment you need. It includes, but is not limited to:

• Getting treatment and services
• Helping you understand what your health insurance covers, including treatment options, second opinions, and referrals to other providers
• Helping you understand your insurance options if you’re not insured

Paying for treatment. This means helping you find ways to pay for your health care costs. This may include, but is not limited to:

• Getting approvals and payments from your health insurance
• Appealing (asking for review of) insurance denials
• Applying for government programs, like Social Security Disability Insurance (SSDI) and the Medicare Low Income Subsidy (LIS)
• Applying to programs that help pay for your co-payments, co-insurance, or health insurance premiums

Paying for living expenses. This includes, but is not limited to, helping you:

• Apply for programs that can help pay for things like food, rent, electricity, and transportation
• Get discounts or set up payment plans for these things

Employment. This includes, but is not limited to:

• Helping you understand your rights under the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA)
• Getting disability insurance to help with income if you can’t work because of a medical condition. Checking with your employer to see if you have this insurance.

ZERO360 Case Management assistance is provided on a first come, first serve basis to the extent the program has capacity to provide assistance.  You receive ZERO360 Case Management services until we resolve your healthcare issues as best we can or you no longer need or want services from ZERO and PAF. ZERO and PAF provides these services as long as we have money to support them.

• Program requirements

To get services from ZERO360 Case Management, you must:

• Have a diagnosis of prostate cancer. 
• Be a U.S. citizen or permanent resident of the U.S.
• Be getting treatment in the United States or a U.S. territory

When reviewing your information to make sure you meet program requirements, ZERO and PAF does not make decisions based on:

• Your healthcare or service provider
• Drug therapies, services, supplies, or suppliers you use
• Who referred you to ZERO360 Case Management
• A relationship you have with or a referral from any ZERO or PAF donor

You can change your providers, treatments or services at any time. They don’t affect your being in the program.

• Patient privacy

ZERO and PAF are committed to protecting your personal information. As part of ZERO360 Case Management, you share things about yourself and your health with us. We keep your information safe and private.

ZERO and PAF may use your information to provide services to you only with your permission or permission from your chosen representative. This can be a family member, care giver or legal guardian. To identify your chosen representative to ZERO or PAF:

• You can identify them on your first call to ZERO360 Case Management.
• Your representative can make the first call to ZERO360 Case Management for you.

You or your representative may give permission to others to share your information with ZERO or PAF. For example:

• You may ask a healthcare or service provider to contact and work with ZERO or PAF for you. When you do this, you give the provider permission to share your information with ZERO or PAF.
• You and your ZERO360 Case Manager may talk directly to someone from an organization about an issue you’re working to resolve. As you’re on the phone together, you give permission for the organization and ZERO or PAF to share your information.

ZERO or PAF may ask for these kinds of information:

• Individually identifiable information. This is information, that is just about you. For example, your name, birthday and Social Security Number are kinds of individually identifiable information.
• Protected health information. This is individually identifiable information that’s about your health. It includes things like your health condition; your healthcare provider and health insurance; and treatments and services you’ve received and payments for them.
• Contact information. This includes your mailing and email addresses and your phone number.

You or your representative give this information voluntarily (not forced) to ZERO or PAF. The information can come from you, your chosen representative, or providers, including:

• Healthcare providers, healthcare settings, labs, pharmacies, and medical equipment providers
• Government health and welfare plans and programs
• Other assistance programs (not government)
• Insurance companies
• Employers and benefit managers
• Lenders, including banks and credit companies
• Utility services, like water and electricity

Here’s how ZERO or PAF may use your information:

1. ZERO or PAF representatives may use your personal information to:
2. Provide services and support to you as part of ZERO360 Case Management. ZERO or PAF may offer these on its own or may partner (work) with other organizations.
3. Contact other organizations and services to help resolve the issues you’re asking ZERO or PAF for help with
4. Evaluate ZERO360 Case Management to make sure it’s helpful to patients
5. Respond to requests for patient records as required by law

            ZERO and PAF representatives can include:

• All ZERO and PAF employees
• ZERO and PAF Directors and Officers
• Staff of partner and service provider organizations who work with ZERO or PAF to provide case management and other patient programs and services

• ZERO or PAF may send you information by mail, email or phone while we’re working with you and after your issue is resolved. This information may be about ZERO or PAF programs, events, research and fundraising. To remove your name from our mailing list, call 844-244-1309.

• ZERO and PAF may use your information in certain reports, including research reports, that review patient needs and program success. These are called de-identified reports. This means they include information from many patients and do not identify individual patients. They do not include things like patient name or identification (ID) number.

• ZERO and PAF will not sell or rent your personal information, including your protected health information, to anyone.

• ZERO and PAF will not share your personal information with anyone from another organization unless it’s:
• Needed to resolve an issue that you’ve asked for help with
• Needed as part of an application for another assistance program
• Used to assess ZERO360 Case Management success
• Required by a ZERO or PAF partner organization
• Required by law