Cowlitz Indian Tribe

Contract Health Services are services provided by private doctors and hospitals that tribal facilities are unable to provide.  CHS is used in situations where:

¨ No tribal or IHS direct care facility exists within 60 miles of you.

¨ The IHS or tribal clinic/facility cannot provide the required emergency or specialty care.  In this case, a referral will be made by the attending Nurse Practitioner.  This referral must be approved in advance by the Cowlitz CHS office.

¨ A patient’s alternative resource dos not cover 100% of the cost of medical care.

¨ Every visit will require prior authorization. 

¨ All dental visits after initial appointment will also need pre-authorization.

¨ Services that may be covered by CHS:  Medical, Dental, RX, Optical, etc.

¨ Annual dental limit: $1,500.00, with prior approval.

¨ Amalgams (silver fillings) on molars.

¨ Composites (White fillings) on front teeth ONLY!

¨ Sealants covered on permanent molars.

¨ Payment of CHS services are determined by priority of procedures and not cost.  All members, whether they have insurance or not should have access to the same level of care.  This is strictly adhered to.

Contract Health Service Eligibility

To be eligible for CHS you must be enrolled with the Cowlitz Tribe and must reside within the Contract Health Service Delivery Area (CHSDA ).  For those moving into the service area, you must reside within the CHSDA for 60 days before residency is established.

 

The following documents are required when applying for services.

· Birth Certificate

· Driver’s License, State ID Card, or Social Security Card

· Proof of residency:  Phone bill, electric bill, rental agreement, student enrollment, etc.

· Tribal Identification

· Primary Health Insurance Card:  Medicare, Medicaid, Regence, Premara, First Choice, etc.

· Proof of application to State for alternate resources or denial letter from state (this applies to you if you are a Cowlitz Member or any other American Indian / Alaskan Native and do not have insurance of any type).  Benefits Counselor available for assistance.

Contract Health Services

Special Circumstances

Students and Foster Children – Students attending college full-time, maintaining a continuous course of study, may be eligible.  Eligibility must be determined prior to leaving for school.

Eligibility shall be extended to those non-Native women pregnant with a CHS eligible Cowlitz Tribal Member’s child during pregnancy and through post-partum.  The non-Native must reside in the same home as the Cowlitz Tribal Member.

Alternative Resources

You are required by federal regulation to apply for an alternative resource if there is a reasonable indication that you may be eligible.  If you are eligible for an altercative resource and you refuse to apply for or refuse to use that alternative resource you will be denied CHS.  The Tribal member is required to fulfill all requests from the alternative resource agency.

CHS is payor of last resort for eligibility persons and is not an entitlement program.  The use of alternative resources is Federally mandated.

Patient Rights and Responsibilities

As a patient, it is your responsibility to register with the Cowlitz Tribal Health services and CHS.

Please do not rely on your provider to notify CHS staff of your appointments.

Prior Approval

72-hour notice – When emergency treatment is received you have 72 hours to notify the CHS office.  A voicemail system is available to you during evening and weekend hours.  If you seek treatment for non-emergency services at a hospital, payment may be denied.  An emergency is not defined by the location where treatment was received and is limited to treatment

where life or limb is threatened.

Contact Information

Please contact us at 360-575-8275 or

1800-301-3461 WA only

 Please request to speak with CHS staff

We are located at 1055 9^th Ave., Suite A

 Longview, WA 98632

Our office hours are Monday-Friday 8a.m. – 5p.m.