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About Siletz news letter. (Siletz, Oregon) 1989-1997 | View Entire Issue (June 1, 1990)
SILETZ, OREGON June 1990 - Siletz Tribal Health Medical Advice Submitted by Bonnie Petersen A previous article in the Siletz News noted that a trip to the hospital for emergency medical treatment costs considerably more than an office visit to a regular physician. Often it's difficult to decide whether or not a medical condition can await treatment until the next day or through the weekend unitl Monday. Many communities offer dial-a-nurse services that can advise in these situations. This assistance is also available through hospital emergency rooms. If you need advise for after- hours or weekend medical treatment, call the hospital and ask to speak with the emergency room nurse on duty. The nurse can offer advice based on the patients symptoms. This assistance is available at Pacific Community Hospital to Siletz area residents by dialing 265- 2244 and to South Beach residents at 867- 4141. UNPAID HEALTH BILLS? Submitted by Bonnie Petersen Once the required documentation reaches the Siletz Tribal Health department, it takes less than two weeks to process health care bills and generate a check for payment to vendors. Yet there are still occasions when tribal members have contacted the Contract Health Service (CHS) clerks concerned about unpaid bills. In order to pay a bill, the CHS clerks need to receive a bill and for cases where there is a primary insurance the clerks also need a copy of the Explanation of Benefits (EOB) from the insurance company. There can be several reasons why the paperwork is delayed or not received by the clerks. In some cases vendors are sending their billings to the Western Oregon Service Unit at Chemawa. Tribal members who receive CHS from Siletz need to make their doctors aware of the new billing address: Siletz Tribal Health, P.O. Box 549, Siletz, OR 97380. Those tribal members who have a primary insurance should ask their doctors if they bill both the primary insurance and Siletz Tribal Health. In many cases, vendors will only bill the first insurance, leaving responsibility for the balance due up to the patient. When this is the case, the patient needs to send copies of the bill and the EOB to Siletz Tribal Health. In rarer instances, the vendor is only billing the patient. Anyone receiving bills should forward them on to the CHS clerks to ensure they will be processed for payment. be paid on a more timely basis. Anyone with questions or needing assistance with billing can contact the clerks at 1-800-628-5720. ALTERNATE RESOURCES: STRETCHING HEALTH DOLLARS Use of alternate resources is one of the many regulations governing the Tribes' Contract Health Services (CHS). The CHS clerks are required to carry out this regulation, ensuring that clients use other available resources before using direct care funds. The most visible resource available is the Chemawa Clinic. Individuals who live within 25 miles or a 30-minute radius of Salem are required to first go to the the clinic for services. If it's determined that the services needed are not available at Chemawa, the clinic doctor can refer patients out to a private provider. Siletz CHS patients that are referred out, still need to contact the CHS clerks for authorization. Use of the clinic also applies to having prescriptions filled. CHS clients can call the Chemawa pharmacist at 399-5931 to see if their prescriptions can be filled through the clinic. If a prescription is not available, then clients should contact the CHS clerks for authorization to go to a private pharmacy. • The CHS clerks forward the report to Dr. Nurre at Chemawa. As the Siletz Tribe's referring physician, Dr. Nurre reviews the information and makes a recommendation to the CHS clerks. If he recommends the referral, the clerks can authorize an appointment for an initial evaluation. This process usually takes about a week. In emergency cases, the referral can be conducted by telephone. For further information on referrals, please contact the CHS clerks. Judy John, Health Director: 1-800-922-1399 CHS Health Clerks: 1-800-628-7520 Shannon Welch Bonnie Petersen Angella Robertson As the Chemawa Clinic provides services to Indians from many tribes, there will be times when an individual cannot get an appointment within a timely manner. In such instances, patients should contact the Siletz CHS clerks and request authorization to see a doctor outside the clinic. Less well-known are resources available through the State of Oregon’s Adult and Family Services (AFS) program. AFS offers various medical assistance programs for adults, as well as for families. Eligibility is based upon income and medical need. If the CHS clerks determine that one of these programs may be a possible resource, patients will be required to apply for medical assistance. While clerks can still obligate funds for medical care, payment will be withheld pending a verification from AFS that the applicant is or is not eligible for assistance. Other possible resources include Medicare, SAIF, motor vehicle insurance, and workmens compensation. Anyone with questions regarding the use of alternate resources can contact the CHS clerks for further information. OBTAINING MEDICAL REFERRALS Submitted By Bonnie Petersen One task that the CHS clerks have set for themselves is to periodically review the suspense files where unpaid bills are held. With only two staff people it has been difficult to find time to do this. But, with the addition of a work' experience position through the Tribe's JTPA program, this has been added as a regular duty. Siletz Tribal Health hopes that with this increased staff effort and assistance from tribal members in forwarding- billing and insurance EOBs to the CHS clerks, that bills can PAGE 7 Contract Health clerks still receive requests from tribal members on how they can get in to see specialists. Requests are handled in the same manner as they were at Chemawa. All referrals to specialists must originate from a patient's regular doctor (in most cases, a general practitioner). This doctor submits a written report to the Siletz Tribal Health Department, detailing a patient's medical status and the reasons for rjsferr^ to a ^speci alist. GLORIA DURBIN STEDCO RECEPTIONIST Gloria Durbin is the new receptionist for STEDCO. Gloria has recently moved here from Wyandotte, Oklahoma to be close to her fam ily. In Wyandotte she was employed as a receptionist/data clerk for the Eastern Shawnee Tribe of Oklahoma for eight years. Gloria was also the secretary/treasurer for the Wyandotte Tribe of Oklahoma, of which she is a member, for thirteen years. Although working for STEDCO is a new experience, she feels very comfortable in her new position because she is familiar with Tribal operations^ She finds "the working conditions pleasant and is enjoying living on the Oregon Coast. . .
