Dental care is limited to $1,000 of approved dental care per patient, per
calendar year. Remember to call and receive a preauthorization for dental
appointments. Make your dental provider aware of any other insurance that you
may have that will assist with dental costs. If a procedure cannot be paid for,
it will be placed on a Deferred Services list. Patients will receive a letter of
confirmation when placed on the list. Patients will be notified when funds are
available. CHS operates under a Priority III basis. Services not deemed Priority III
will be added to the Deferred List at the patient’s request.
PRIORITY I: Urgent and emergent care that must be done within 30 days to
preserve life, limb, function or senses.
PRIORITY II: Non-emergent care that
is needed within 30-60 days, but enough time during which alternate resources
can be evaluated.
PRIORITY III: Elective care that can be safely deferred
for more than 60 days.
PRIORITY IV: Luxury procedures such as cosmetic
surgery.
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 Health
& Wellness Center (GRH&WC)
Keep your Insurance. If you have health insurance we can pay for your
deductible and any balances after the insurance company pays — assuming you meet
all requirements of our CHS program. For those who have insurance, all
correspondence from insurance stating what they have paid or denied must be sent
to us within 60 days (private insurance, Medicare, etc.) If you fail to comply
with the requirements of your primary insurance, CHS may deny payment. We pay
only after all alternate resources have responded.
Your responsibilities are: you need to phone in appointments 3 to 7 days in
advance for preauthorization and to receive a confirmation number even if you
have insurance, Medicare, Medicaid, Private, etc. Inform doctors of private
insurance, Medicare, or Oregon Health Plan or other alternate resources that
cover medical or dental services. Mail CHS all pre-authorized bills, insurance
explanation of benefits. All patients receiving elective surgery must receive
PRIOR APPROVAL from a doctor at GRH&WC. These services will be rendered upon
availability of funds. If you reside within 25 miles of the GRH&WC or the
Chemawa Health Center, you will need to receive medical and dental services from
one of these facilities. If you are in need of a referral to a specialist, the
referral must come from a Medical or Dental Provider in one of these clinics.
CHS is only able to pay for Priority III levels of service outside of these
facilities and proper use of your alternate resource is also necessary. Every
appointment must be called into CHS three to seven (3-7) days prior to receiving
services (emergency room services require that CHS be notified no later than 72
hours after being seen. Emergency room services will be reviewed by the Clinic
provider to determine the priority level of the service). Confirmation numbers
will be given for all preauthorized appointments.
The Contract Health Service program is federally funded under P.L.93-638 by
Congress for the Grand Ronde Tribe. To receive services through this program,
one must meet the Contract Health Service eligibility requirements outlined
above. All routine medical care, including follow-up visits, must have prior
approval.
The Notice of Privacy Practices for the Grand Ronde Health & Wellness Center is available to you by following this link: Click Here