2014/2015 OOA Health Benefits
CONTRACT HEALTH SERVICES
For July 1, 2014, through June 30, 2015
Preventing Denials
The Tribal Council has approved the following plan for using the 2014/2015
Out-of-Area Health Benefits (OOA). To qualify, Tribal members must be reg-
istered for health care with the Siletz Tribal Health Department – and – reside
outside the Tribe’s 11-county service area. These funds are intended for Tribal
members who are not eligible for Contract Health Services (CHS).
1. When using CHS, you must have every appointment pre-authorized by
obtaining an authorization number within 24 hours of services rendered.
2. If you’re going to a specialist appointment (not your primary care
physician), it must be approved through Gatekeeping. This means your
doctor must fax referrals and chart notes by Tuesday of each week for
consideration on Wednesday morning. If approved through Gatekeeping,
you must then obtain an authorization number from your CHS worker
within 24 hours of appointment.
One of the following benefits is available per fiscal year:
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3. When going to the ER or urgent care, you must notify CHS within 72 hours
of the visit. The ER and urgent care must be a last resort – if the service is
deemed inappropriate, CHS will not cover the service. You must utilize
your primary care doctor when possible.
$400 – Vision
$1,200 – Dental
$2,000 – Hearing
$1,000 – Medical
Plus $500 maximum Pharmacy thru Pequot Rx
Prior authorization by CHS is required and benefits must be used within 90
days. The claims must be in to CHS by the end of the 90-day funding period.
Any funds not used within 90 days or claims not received will be returned to
the pool for re-distribution.
4. CHS requires you to apply for alternate resources. This means you are
required to apply for the Oregon Health Plan if you do not have other
insurance, such as Moda, Blue Cross/Blue Shield or Medicare. If you are
over-income for alternate resources, you can provide that proof to CHS
and they can issue a waiver for that year.
An individual can only access benefits one time per fiscal year. When you
call for pre-authorization, CHS will authorize for household members only.
Authorization will not be granted for anyone not residing in your household.
Voicemail messages do not hold funds, must be live contact.
Call CHS starting at 8 a.m. on April 1. If you are not already registered for
health services, please call anytime to request an application. If you need to
update your information, please call CHS and your information can be updated
over the phone.
CHS Phone Numbers
Toll-free – 800-628-5720
Local – 541-444-1236
Fax – 541-444-9645
800-628-5720 or 541-444-1236
Blood Pressure
Quotation of the month
Blood pressure is the force of blood flow inside your blood vessels. Blood moving through
your vessels with too much force (hypertension) causes your heart to work harder, thus
raising your risk for heart attack, stroke, eye problems, diabetes, and kidney disease. If
you already have diabetes, you are at an increased risk for developing these diseases.
“Diabetes is like a roller coaster. It has its ups and downs,
but it’s your choice to scream or enjoy the ride.”
Normal blood pressure: 120/80 mmHg
Blood pressure goal for people with diabetes: 140/80 mmHg
The top number (systolic) measures the pressure in the arteries (when the heart
contracts) The bottom number (diastolic) measures the pressure in the arteries between
beats (when the heart muscle is resting and refilling with blood)
High blood pressure, like high blood sugar (glucose), is a medical condition that you can
dramatically improve by making a few simple life style changes:
If you have diabetes, are pre-diabetic, or are a support person for some one with diabetes,
please consider joining us monthly for a talking circle or diabetes education class!
Eugene Area Office teams up with the health educator from the Coquille tribe and offers
diabetes prevention classes. The next class offered will be March 12 from 6-8pm at 2468
W. 11th ave.
Contact Adrienne Crookes at 541-484-4234 for more information
Salem Area Office will be hosting its next talking circle/ luncheon March 12 from noon to
1pm at 3160 Blossom Dr NE. suite 105.
Contact Cecelia Tolentino at 503-390-9494 for more information
Portland Area Office hosts its talking circle/luncheon the second Wednesday of every month
from noon to 2pm at 12790 SE Start St. suite 102.
Increase physical activity– this will also help with weight management
Eat less processed and more whole foods (fruits, vegetables, whole grains)
Quit smoking
Limit alcohol consumption
Decrease salt consumption by choosing foods with less than 400mg of sodium per
serving– try seasoning food with herbs and spices!
Talk with your primary care doctor about other treatment options
Kale Chips are very satisfying if you find yourself craving a crisp and greasy potato
chip, and are really easy to make too!
Ingredients:
1 bunch of Kale, rinsed with leaves stripped from stem
1 Tbsp olive oil
Salt and pepper (or your choice of seasoning)
Contact Verdene McGuire at 503-238-1512 for more information
Preheat oven to 350, lay kale in a single layer on a baking sheet
Siletz Area hosts its talking circle/luncheon the fourth Thursday of every month from noon
to 1pm at the Tillicum Fitness Center 1016 W Buford St.
Drizzle 1 Tbsp olive oil over kale, then season to taste.
Contact Kayla Engel at 541-444-9661 for more information or to sign up
Bake on the center rack of the oven for 10-20 minutes, or until Kale is crisp
and the edges begin to slightly brown.
ENJOY!!
March 2015
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SiletzNews
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