Emergency Room or Hospitalization
Emergency room treatment or hospitalization is the only exception to the advance authorization requirements. The patient must, however, notify the Medical Unit at their local Health Center within 72 hours (3 days) after receipt of emergency room or urgent care services. Also, after release, a copy of the patients discharge form must be turned into the health center.
The patient will need to sign a “Release of Information” form so that copies of his/her medical information may be obtained by the Health Center. Failure to do so will complicate the handling of these charges and may result in denial of payment.
Purchased/Referred Care Services – Eligible Patients
Upon registration at the hospital, you will be asked for insurance information. You should notify the hospital, not only of your health insurance/Medicare/Medicaid. The PHC is always the payer of last resort, which means that we will cover what your insurance company does not. Part of your eligibility requirements for this coverage is that you must try to seek a separate form of coverage other than relying solely on the PHC and Indian Health Services for payment. Please see a Patient Benefits Specialist at PHC for assistance in meeting these requirements.
Receiving A Bill After Service
Occasionally, the patient may receive a bill from services rendered outside of the Health Center. In order to notify the outside provider to submit the claim to the PHC Purchased/Referred Care Services for payment processing, the billing statement must be presented to PRC as soon as it is received. If you are eligible for Purchased/Referred Care Services and receive a bill, please drop it off at PHC for processing.
If you have any further questions regarding eligibility, patient rights and responsibility, Purchased/Referred Care Services, or referrals, see the informational links to the left or call us.
