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.
.
.