Navigating Health Care Costs at
Non-Tribal Facilities

By Revenue Cycle Supervisor of Outreach and Enrollment Ariel Berg and Senior Public Relations Specialist Michelle Mincks

During a medical emergency, many people aren’t thinking about the cost of life-saving measures. According to a recent survey, 60% of Americans have had debt from medical bills, with emergency visits as the leading cause. A phone call to Purchased and Referred Care, formerly known as Contract Health Services, could provide relief from costly bills that may come after an emergent or urgent care visit.

“We process more than 150 claims per month on average,” said Southcentral Foundation Outreach and Enrollment Supervisor Zach Fuqua, who oversees the SCF PRC team at Benteh Nuutah Valley Native Primary Care Center. Fuqua shared that SCF PRC primarily assists customer-owners who reside in Matanuska-Susitna Borough with emergent visits to Mat-Su Regional Medical Center emergency room.

PRC has limited funding available to assist customer-owners with payment for urgent or emergent medical needs. Urgent visits are categorized as health issues that need immediate attention, that would otherwise become an emergency if not treated. Emergent visits are events that present an immediate threat to life, limb, and/or eyes.

According to the Indian Health Service, this funding is part of the PRC program where IHS and Tribal facilities purchase private health care from providers in situations where:

• No IHS or Tribal direct care facility exists;
• The existing direct care element is incapable of providing required emergency and/or specialty care;
• Utilization in the direct care element exceeds existing staffing; and
• Supplementation of alternate resources (e.g., Medicare, Medicaid, or private insurance) is required to provide comprehensive health care to eligible Alaska Native or American Indian people.

Additionally, if you require services the Alaska Native Medical Center doesn’t provide, a referral may be needed to a non-Tribal facility. A call to PRC can help you navigate the process.

Customer-owners who reside in the Municipality of Anchorage and are empaneled at Anchorage Native Primary Care Center should call the ANMC PRC at (907) 729-2470. Customer-owners who reside in the Matanuska-Susitna Borough and are empaneled at VNPCC should call SCF PRC at (907) 631-7681.

It is essential to contact PRC before receiving services at any non-Tribal health care facility, or within 72-hours of an emergency room visit to avoid a bill in the mail. “A customer-owner who does not follow this process could be billed for medical services,” said SCF Revenue Operations Administrator Michelle Wenger. “Ultimately, if they do not follow up with Purchased and Referred Care regarding an eligibility screening, they might have their bill sent to collections and be responsible for payment.”

To be eligible for PRC funds, you must be an empaneled Alaska Native or American Indian customer-owner and meet the following guidelines:

• Call PRC within 72-hours of emergency room visit.
• Provide information on your current health insurance status and complete a health benefits eligibility screening.
• If found eligible, apply for Medicaid, Denali KidCare, and/or payment programs.
  Meet the urgent and/or emergent guidelines.

“Our team is here to assist customer-owners with navigating this process, and ensuring they follow the right steps,” said Wenger.

According to the Indian Health Service the Consolidated Appropriation Act of 2014 renamed the Contract Health Services program to the Purchased and Referred Care program in January 2014. For more information, call Benteh Nuutah Valley Native Primary Care Center Family Health Resources at (907) 631-7830. Source: LendingTree survey, Feb. 2021.