Purchased Referred Care
Purchased/Referred Care (PRC) is a financial resource to assist in payment for services that cannot be directly provided at the Oneida Community Health Center and Oneida Behavioral Health based upon eligibility. Federal regulations require that PRC funds are to be used only after all alternative resources have paid.
PRC eligibility will be determined by a PRC Specialist based upon federal regulations and a referral from your primary care provider at the Oneida Community Health Center and/or Oneida Behavioral Health.
All patients seeking PRC funds must provide a current PRC Service application and one form of documentation for proof of residency, tribal affiliation, and are required to apply for alternate resources for care.
All patients must notify PRC of going to the Emergency Room or Urgent Care within 72 hours to be eligible for PRC coverage. For Elders, aged 55 and over, notification must be made within 30 days.
Please see the important information in the following tabs.
Following are links to the PRC applications:
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- Fillable Form (to be completed on computer)
- Non-Fillable Form (to be printed out and completed)
Eligibility criteria
Eligibility is determined by the following:
- Be an Oneida tribal member or descendent residing within Brown or Outagamie County
- Member of another federally recognized tribe residing in Brown or Outagamie County with a social or economic tie to the Oneida Nation (work for Oneida, married to Oneida member/descendant, caring for Oneida children
- Member or descendent of another federally recognized tribe residing within the Oneida Reservation boundaries
- For minor dependents who reside with both parents at separate addresses, eligibility will be based on what address is used for enrollment in school, or what address schooling is facilitated at. Verification of school enrollment may be requested
- Students who meet eligibility guidelines at their permanent residence prior to leaving for school must supply PRC with a copy of full-time student status every semester
- Patients, eligible but leaving the community, may continue to be eligible for 180 days
- Non-Native American women pregnant with an eligible Native American’s child are eligible for: duration of pregnancy through post-partum, as long as prenatal care is done through OCHC or referred out by an Oneida provider (Father’s Acknowledgment form must be signed prior to receiving PRC funds)
- Provide a current PRC Service application (updated annually)
- Provide acceptable form of proof of residency
- Apply for alternate resource for care if patient eligible
- Prior authorization must be determined by patients primary care provider from Oneida Community Health Center or Behavioral Health
- Oneida Community Health Center or Behavioral Health provider must issue a referral for services
Proof of Residency
Documents acceptable for proof of residency must include the patient’s name and physical address and be dated within the last 60 days. See the list below:
- Official government documentation
- Rental receipts or documentation from mortgage holder or landlord on letterhead
- Direct deposit receipts or payroll stubs
- Acceptance letters( college/grants)
- Utility bills (heat, water, sewer and garbage disposal)
- Cable, satellite bills
- Telephone and cell phone bills
NOTE: Your name, address and current date must be visible, and it must be a current document from within the past 60 days.
- Acceptable forms of tribal affiliation will include: tribal identification cards and descendent letters
- Applications for alternate resources may include but are not limited to: Medicare, Medical Assistance, Wisconsin Well Women’s Program, Disability, Kinship Care, Express Enrollment for Pregnant Women and Children, etc. Patients are expected to remain compliant with alternate resources to receive Purchased Referred Care funds.
General E-mail Address
Purchased/Referred Care
OHC_PRC_Services@oneidanation.org
You are now able to scan and email us the following documents:
- Bills for Purchased/Referred Care
- Proof of Residency
- Purchased/Referred Care Application
- Proof of Income
- Notification of emergency room or urgent care visits (see Emergency Situations tab for more information)
Please NOTE: It is not acceptable to send cellphone pictures of documents required.
Questions? Please call Purchased/Referred Care at 920-869-2711
Emergency Situations
- For after-hours urgent or severe medical problems, go directly to the hospital and notify PRC within 72 hours. Tribal elders aged 55 and over are allowed 30 days to notify PRC. All ER and Urgent Care visits require notification even with an active referral for care for a condition that is related to the emergency.
- Unsure about a medical situation? Call OCHC to seek medical advice by calling 920-869-2711, which is available after hours by an answering service. An on-call provider will be contacted to call you.
- When seeking emergency care outside of Brown or Outagamie County, follow the same guidelines above. a. Obtain information regarding the facility you went to and provide that information when you notify Oneida of the visit.
- Request records be sent to your Oneida provider at OCHC.
- After hours prescriptions: Oneida’s preferred provider is Walgreens located at 116 North Military Ave, Green Bay, WI 54303. Oneida members will need to present their insurance information (if applicable) and Tribal ID/descendent letter. If it is not possible to utilize this pharmacy or if Tribal ID is not presented/available, keep original paperwork and receipts to request reimbursement. Submit reimbursement requests to PRC Supervisor.
Please note: Patients need to utilize the Oneida Pharmacy if it is open, or you may not be eligible for reimbursement. Utilizing an outside pharmacy is for emergency or pre-approved situations.
Medical Benefits
Are You Eligible for FREE Health Care Programs?
At Oneida Comprehensive Health, we understand that healthcare can sometimes require specialized services, and that’s where purchased referred care (PRC) comes in. While PRC is not insurance, it is a financial resource that can assist in covering the cost of services that may not be directly available at our facility. PRC funds are only accessible after all alternative resources have been utilized. PRC services are available to those who are eligible.
If you don’t have insurance, you only have Medicare Part A or Medicare Part A and B, you may qualify for several free programs that can help with healthcare costs, and signing up before you need them can help speed up the reimbursement process.
There are various free Medicaid programs available to assist with healthcare needs:
- Wisconsin Well Woman: Costs for breast and cervical cancer screenings including exams and mammograms, paps, pelvic exams and HPV tests in addition to Multiple Sclerosis testing.
- SeniorCare: Assistance with prescription drug coverage.
- Badger Care Plus: Typically covers most health care costs including prescription drugs.
- Family Planning Only Services: Covered services are contraceptives, pap tests, voluntary sterilizations and treatments for STDs.
- Specified Low Income Medicare Beneficiary: Patient must have Medicare Part A & B – program pays for Medicare premiums on behalf of member, member still pays for co-pay, co-insurance and deductibles.
- Qualified Medicare Beneficiary: Patient must have Medicare Part A & B – program pays for Medicare premiums on behalf of member but also co-pays, co-insurance and deductibles.
Our Medical Benefit Coordinators (MBCs) are here to help you determine whether you qualify for any of these programs. MBCs are available Monday through Friday, from 8:00 a.m. until 4:30 p.m. in the former registration area of the clinic. They can help screen you for these programs and answer any questions you might have about the benefits they offer. Contact us at (920) 869-2711 option 5 or at OHC_PRC_services@oneidanation.org for more information.
