September 1994 -tr Page 8
Health and Human Services
Smoke Signals
Contract
What is Contract Health Care?
The Contract Health Service
program is federally funded under
P.L. 93-638 by Congress for the
Grand Ronde Tribe to assist eligible
Indian people with payment of
eligible medical anddental services.
Who is eligible?
Contract Health Services is
restricted to those individuals and
their minor dependents who (1)
live on an Indian reservation or
other trust land, (2) live off of the
reservation, but reside within the
service area and be a member of the
Tribe for which the service area
was established.
Enrolled Grand Ronde tribal
members must reside within the
counties of Washington,
Multnomah, Marion, Polk,
Yamhill, and Tillamook. All
services must be preauthorized by
the Contract Health programbased
on medical priority.
Priorities for Contract Health
Services
Priority I: Emergent or Acutely
urgent careUrgent and emergent
care must be done within 30 days to
Dental clinic
Kids: Remember to
brush and floss
By Dr. Scott van Dyken
Everyone has probably seen that
commercial on television with the
slimy green guy "Mr. Yuck Mouth"
and how he talks about the effects
of not brushing and flossing your
teeth and gums. Well, believe it or
not, he is not too far off. When we
don't brush, plaque, (a combination
of food product, saliva, and
BACTERIA) sticks to the teeth.
This plaque is a substance that
must be taken off with a toothbrush
and floss before the acid content in
the plaque reaches levels that are
harmful to our teeth. This acid
content reaches harmful levels about
28 hours after contact.
If you were to brush and floss
your teeth perfectly once a day, you
would be protected; however, most
people usually miss those "hard to
reach" places on their teeth so it is
better to brush and floss twice per
day.
Brushing and flossing twice per
day will keep away bacteria in
plaque, and you will be rewarded
with a brighter and happier smile.
Let's talk teeth...
By Linda Mann, RDH
Diabetic smokers, ages 45 and
Health
preserve life, limb, function, or the
senses.
Priority II: Preventive care
Primary health care that is aimed at
the prevention of long term
disability. This includes services
proven effective in avoiding the
occurrence of a disease (primary
prevention) and services proven
effective in mitigating the
consequences of an illness or
condition (secondary prevention).
Priority II services are available at
most Indian Health Service
facilities.
Priority III: Primary and Secondary
care Inpatient and outpatient
services that involve the treatment
of prevalent illnesses or conditions
that have a significant impact on
morbidity and morality. This
involves treatment for conditions
that may be delayed without
progressive loss of function or risk
of life, limb, or senses. It includes
services that may not be available
at many IHS facilities and may
require specialty consultation.
Priority IV: chronic Tertiary and
Extended care Inpatient and
outpatient care services that require
(1) a specialist or sophisticated
news
older have a greater chance of
developing severe periodontal
disease with loss of tooth
supporting bone than people
without those risk factors. That
was the conclusion of a study
conducted at the State University of
New York at Buffalo. In light of
this finding, regular dental care for
the diabetic patient is crucial. Good
oral hygiene must be routinely
practiced at home. It is important
to brush after meals and snacks. In
choosing a toothbrush, make certain
it is soft-bristled.
This is important in preventing
damage to your gums. Flossing is
one of the most effective ways to
clean in between your teeth where
the toothbrush cannot reach.
Remember home care procedures
are very important, but it is also
important to visit your dentist
regularly. Dontbeanother statistic;
take care of your teeth, and they
will help take care of you.
Dental clinic services
The Grand Ronde Dental clinic
staff believes that dental health is
very important to overall general
health. It is our goal to provide
quality dental care in a professional
and caring manner.
The dental team consists of one
questions
equipment and tertiary care
facilities, (2) that are not essential
for initialemergent diagnosis or
therapy, or (3) that are high cost,
elective, and have less impact of
mortality that morbidity. These
services are not readily available
from direct care IHS facilities.
Who determines priorities?
The priorities are determined by
Indian Health's operational
procedures. The interpretation of
the priorities for our tribal health
program is determined by
consultation with professional
health care providers at the Grand
Ronde clinic and Chemawa Service
unit.
How do I use Contract Health
Services?
Patients need to establish their
eligibility with Contract Health
Services prior to receiving medical
or dental care. You can receive a
health application by dialing 1-800-775-0095
and requesting one
applicationfor eachfamiry member.
After eligibility is established, you
will need to phone in appointments
3-7 days in advance for
dentist, one hygienist, two dental
assistants, and a dental receptionist
We also have an orthodontist who
provides servicesonalimited basis.
The Dental clinic provides basic
services to all Native American
descendents. They include: exams,
cleanings, fillings, crown and
bridge work, full and partial
dentures, extractions, and root
canals.
For procedures requiring
laboratory services, the "direct" or
"self-pay" patient is responsible for
the fee incurred.
Patients are seen at the Dental
clinic Monday throughFriday, with
the exception of legal holidays.
Clinic hours are 7:45 a.m. to 4:45
p.m. Emergency walk-in time is 8
9 a.m. Patients requesting
emergency treatment should
register with the receptionist no
ater than 8 a.m.
"No Cavity Club'
Congrats to our new
members:
Matthew Castelon
KaylaLeno
Nicole Porter
Anthony Stone
Samantha Stone
answered
preauthorization, even if you have
insurance, medicare, or medical
assistance through the state.
Emergency visits have to be
reported within 72 hours after the
services. (Emergency room
services will be reviewed by the
Family Nurse Practitioner at the
Tribal Clinic, for priority level of
the emergency service.)
Inform doctors of private
insurance, medicare or other health
coverage you may have. Mail CHS
allpreauthorizedbillsand insurance
explanation ofbenefits to: Contract
Health Services, 15 GrandRonde
Road,GrandRonde,Oregon97347.
Inpatient hospital stays
All patients that do not have an
alternate resource and are going to
be hospitalized must apply for
medical assistance through the
Oregon Health Plan. Refusal to
apply for alternate resources will
result in denial of payment
Should I keep my insurance?
Yes, by all means. If you have
health insurance we can pay for
your deductible and any balances
after the insurance company pays,
assuming you meet all the
Nanitch Sahallie's
Nanitch Sahallie is a youth
residential treatment facility
located in Keizert Oregon, It is
owned and operated by the Grand
Ronde Tribe, To protect client
confidentiality, all printed essays:
wilt be kept anonymous.
For me, treatment kind of woke
me up from my life of ignorance: :
toward my problems and
behaviors. It showed me that I
could make my life into something
great, and it didn't have to be so
miserable. It let me understand
myself and gave me some
confidence, self-esteem, and pride
in my native culture, i learned
why I always gave up and failed,
Most of all I learned how to be
myself and exactly what it is I
want out of life. I have had a
chance to mature greatly, learn
open-mindedness and
willingness.
When I first entered treatment
1 was unhappy; the treatment
center was a place that told me
when to go to bed and when to get
up. After I had been here a while,
treatment has kind of been like a
school that was my family and
home. I have felt trapped and
requirements of theContractHealth
Services program.
If after a determination that there
are no alternate resources
(insurance or other government
programs), we are responsible for
the total charges. The disadvantage
to not having an alternate resource,
is that with limited funds, we may
run short of funds and may not be
able to pay for services. For those
who have health insurance,
medicare, etc., Contract Health can
pay only after the insurance
company has paid.
Contract Health has recently
started mailing and "Explanation
of Benefits" of its own to tribal
members. This will be sent out of
the ContractHealthofrice twice per
year. This document will show all
preauthorized calls and ancillary
charges incurred (lab, x-ray,
interpretation bills). It will state
the care provider's name, purchase
order number, date of service, and
whether the document is "open" or
"paid". If a document is open, this
indicates there has been no payment
of services. Please take a look at
this document, and call us if you
have any questions at 1-800-775-0095
or 879-2000.
Client Corner
homesick at times, but there was
always someone to help me
understand my feelings and that
everything they did was for a
reason. During the bulk of the
stay, 1 felt hopeless in getting out,
but when I talked my feelings out,
I felt better and motivated to
healing myself, I felt focused on
making my life better for me and
those who are a part of it It has
been one hell of a roller coaster
ride in an emotional sense. There
has been pain, joy, happiness,
anger, hurt, confusion, anxiety,
and a lot of other feelings felt I
have applied a lot of open
mindedness and willingness to
make treatment work for me. I
have seen many others go through
hell and then some because they
didn't use open-mindedness and
willingness in their treatment and
recovery, I have learned to live
without everyday things, and
learned about taking those
everyday things for granted,
Above all, treatment' was
something I am grateful for, and
I encourage anyone who has a
chance to go, to go.Jt will change
your life...
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