Coverage for Services
Direct Health Care Service: You are eligible for routine direct health care service that is available if you:
- can prove that you are an enrolled member of a federally recognized U. S. Indian Tribe.
- have provided tribal or Bureau of Indian Affairs documentation that you are a descendent from an enrolled member of a federally recognized U. S. tribe.
- are a pregnant non-Indian female and can provide a marriage license or notarized statement of paternity co-signed by an enrolled member of a federally recognized U. S. Indian tribe. This will make you eligible for prenatal care and one follow-up visit.
- are a non-Indian child who has been adopted, or are a foster or stepchild of an eligible Indian. In such cases, you are eligible until age 19. Documentation must be provided (Court documentation of foster placement, etc).
- are a Commissioned Corps member or immediate family. Proof of Commission Corps status must be provided by the patient.
- are a non-Indian service unit employee. This eligibility is limited to the Employee Health Program and does not include routine health care. The specific types of care included can be found in the Employee Health Manual and are approved by the Infection Control Committee, the Chief of Medical Staff, and the Chief Executive Officer.
- If treatment of a non-Indian is deemed necessary (by a medical provider) to prevent or contain the spread of a disease or public health epidemic, such treatment shall be allowed.
- Emergency health care (as determined by a medical provider) must be provided to anyone in order to prevent loss of life or limb. Ineligible patients will be billed accordingly.
Purchased & Referred Care (formerly Contract Health): You are eligible for Purchased & Referred Care (formerly Contract Health) if you:
- are either a member or descendent of the tribe or tribes located on the Ft. Berthold reservation and you reside within the Contract Health Service Delivery Area (CHSDA). The Ft. Berthold Service Area includes Mountrail, McKenzie, McLean, Mercer, Dunn, and Ward counties in North Dakota. You may be required to provide documentation of your residency (rent receipts, utility bills, etc) for PRC purposes.
- you are a person of Indian descent belonging to any U. S. Indian Tribe; and reside within the boundaries of the Ft. Berthold Reservation; and maintain economic and social ties with the Tribes of the Ft. Berthold Reservation (ie, work on this Reservation, or have family on this Reservation). You may be required to provide documentation of your residency (rent receipts, utility bills, etc) for PRC purposes.
- you are a full-time student, dependent of a full-time student, or foster child. All others are limited to not over 180 days absence from the Ft. Berthold CHSDA. You may be required to provide documentation for PRC purposes.
Difference between “Referral” and “Authorization”
- A “Referral” is a recommendation from a service unit provider that you see a specialist for care that is not available at the Elbowoods Memorial Health Center. It is not a guarantee of payment. A provider may feel that it is in your best interest to see this specialist, or get this test, but because of funding limitations, the service unit may not be able to pay for it.
- An “Authorization” is a guarantee of payment, given when the Referral is within the funding priorities. These vary, depending on availability of funds. The level of care authorized by this clinic is dependent on the amount of money that is received from Congress through the IHS system, as well as additional funds provided by the Three Affiliated Tribes to supplement the PRC program.
To get your hospital bills or specialized care paid through this service unit, you must:
- meet the eligibility requirements regarding Indian descent and residency within the Contract Health Service Delivery Area (counties of Mountrail, McKenzie, McLean, Ward, Mercer, Dunn).
- have an authorization form signed by a service unit official in your hand when you go to a different facility for specialized treatment or other non-emergency care.notify the Purchased & Referred Care office at the Elbowoods Memorial Health Center within 72 hours of any emergency treatment received at a facility that is not operated by this service unit.
- have a reasonable belief that emergency treatment you seek at an outside facility is a true emergency and constitutes the threat of life or is required to prevent permanent bodily harm or disability if treatment is not immediate.
- apply for alternate resources (medicaid, medicare, veterans benefits, crippled children's services, auto insurance (liability), vocational rehabilitation, workman's compensation, etc.) if it is reasonable to believe you may qualify.
- contact the Purchased & Referred Care (PRC) office immediately at the Elbowoods Memorial Health Center if you have a question about a bill. The insurance provider may send you a paper called the Explanation of Benefits form (EOB) which you need to bring into the PRC office right away.
- return to the Elbowoods Memorial Health Center for a new referral and get an authorization form to take with you every time you see a provider outside of the service unit. When an outside provider schedules you for a follow-up visit, this does not constitute an authorization for payment by this service unit so you need to come back to the Elbowoods Memorial Health Center.