Purchased Referred Care
Purchased/Referred Care (previously known as Contract Health) Service is a financial resource to assist in payment for healthcare services that cannot be directly provided at the Oneida health care facilities.
The first step for utilizing purchased/referred care funds is a referral for services must be determined by the patient’s Oneida Community Health Center and/or Oneida Behavioral Health primary care provider. Then a Purchased/Referred Care Representative will determine eligibility based upon federal regulations.
All patients seeking Purchased/Referred Care Service funds must:
- Read the Purchased Referred Care Packet and complete application:
- Fillable Form (to be completed on computer)
- Non-Fillable Form (to be printed out and completed)
- Provide proof of residency
- Provide proof of tribal affiliation. Acceptable forms of tribal affiliation include:
*tribal identification cards, and/or
*descendent letters. - Patients with no insurance must apply for alternate resources for care. Examples of some alternate resources include:
*Medicare
*Medical Assistance,
*Wisconsin Well Women’s Program,
*Disability,
*Kinship Care,
*Express Enrollment for Pregnant women and children
NOTE:
If patients qualify for an alternate resource, they must comply with alternate resource to receive Purchased/Referred Care Service funds.
ATTENTION:
Federal regulations require that Purchased/Referred Care Service funds are to be used only after all other alternative resources have paid.
Eligibility criteria
- 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 (married to Oneida member/descendant, work for Oneida Nation, or taking care of 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. Student must supply purchased/referred care service application with a copy of full-time student status each semester
- Eligible patient that leaves the community, may continue to be eligible for 180 days
- Non-Native women pregnant with an eligible Native American’s child for duration of pregnancy through postpartum, as long as prenatal care is done through OCHC or referred out by Oneida provider. NOTE: The Father’s Acknowledgment form must be signed prior to receiving Purchased/Referred Care Service funds for unmarried parents.
Proof of Residency
Provide one form of proof of residency. Documents acceptable for proof of residency are one of the following:
- Official government documentation
- Documentation from mortgage holder or landlord on letterhead.
- Direct deposit or payroll stubs
- Current active bank statements and e-statements with dates included
- Acceptance letters (college/grants) and dated transcripts
- Utility bills (heat, water, sewer and garbage disposal)
- Cable, satellite, telephone, cell phone bills
NOTE: your name and address must be visible, and it must be a current document from within the past 60 days. Additional forms of proof of residency may be requested to review if address provided is truly the primary residence. False or misleading information provided to PRC will result in a denial of benefits.
Examples of UNACCEPTABLE proof of residency forms: Personal mail, Envelopes, Collection statements, Medical bills, Bulk/junk mail, Vehicle registration renewals.
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.
