What is Purchased and Referred Care?
Purchased and Referred Care is a benefit to eligible un’ina, “those who come to us.” It provides funding for referred or emergency health services at non-tribal medical providers and facilities.
Purchased and Referred Care funds for approved services can assist with medical expenses incurred outside the Dena’ina Wellness Center.
Purchased and Referred Care is not an entitlement or insurance program. Funding is not guaranteed by the Kenaitze Indian Tribe. Eligibility requirements apply.
Who is eligible?
- Un’ina who use the Dena’ina Wellness Center as their primary care provider.
- Non-Alaska Native or American Indian women pregnant with an eligible Alaska Native or American Indian person’s child with proof of paternity from the eligible beneficiary.
- Children of eligible Alaska Native and American Indian people, including foster children, adopted children, stepchildren, legal wards and orphans, until age 19.
- Students temporarily absent from their Purchased and Referred Care Delivery Area during full-time attendance at school.
Additional eligibility information:
- Alaska Native and American Indian people who are Alaska residents for 180 days prior to the date of service and intend to remain in Alaska.
- Must live within the Purchased and Referred Care Delivery Area: Cooper Landing, Kasilof (North Side of Kasilof River), Kenai, Nikiski, Ridgeway, Salamatof, Soldotna, Sterling and Wildwood.
- Must notify a representative of emergencies: In emergency cases, you (or your representative) must notify the Dena’ina Wellness Center within 72 hours of admission to a non-Indian Health/Tribal Health facility. For elderly (65 years of age or older) and disabled, you must notify Dena’ina Wellness Center within 30 days of admission to a non-Indian Health/Tribal Health facility.
Alternate Resources
By law, an Indian Health/Tribal Health facility is the payer of last resort, meaning you must apply for and use all alternate resources available to you before we can authorize payment from Purchased and Referred Care funds.
Alternate resources include: Medicare A and B, Alaska Medicaid, Veterans Compensation, private health insurance, and state and local health programs.
Screening for alternate resources must be completed within 12 months of the referral date. Our staff is happy to screen you for alternate resources and assist in the application process. Please call 907-335-7500 and ask to speak to an un’ina navigator.
Referrals
A Dena’ina Wellness Center medical provider must initiate the referral for non-emergent care, such as routine prenatal care, mammograms, primary and secondary care, or specialty consultant services not available at the Dena’ina Wellness Center.
A referral is not an obligation to pay.
Approval for payment is based on eligibility and availability of Purchased and Referred Care funds.
Services received outside of an Indian Health/Tribal Health facility without a referral are reviewed to determine the level of emergency care.
Patients are responsible for bills that do not meet the criteria of emergency care.
For un’ina who do not have alternate resources, we work with the Alaska Native Medical Center and refer to Anchorage for medical care and travel to and from Anchorage.
What is not covered?
- Medical services provided by non-Indian Health/Tribal Health facilities and/or medical providers, when the un’ina was not referred and/or the services were not authorized by the Dena’ina Wellness Center Purchased and Referred Care Workgroup.
- Inpatient or outpatient mental health services.
- Inpatient or outpatient substance abuse programs.
- Medical care considered investigational or experimental.
- Nursing home or long-term care facilities.
- Routine and specialty dental services.
- Services received at a non-tribal health care facility if the Dena’ina Wellness Center was open and available to provide services the day that care was received.
- Bills submitted to the Purchased and Referred Care Department more than one year after the date of service.
- Emergency services that are the result of drugs and/or alcohol use.
*Not an all-inclusive list
Appeals
If you receive a letter denying use of Purchased and Referred Care funds and would like to submit an appeal, the appeal must be submitted in writing within 30 days. The Appeals Committee will review your file and respond within 60 days.
Submit appeals to:
Dena’ina Wellness Center
Attn: Purchased and Referred Care
508 Upland St.
Kenai, AK 99611
Contact – Location – Hours
508 Upland St.
Kenai, AK 99611
Phone: 907-335-7500
Medical records fax: (888) 491-3360
Behavioral Health department fax: (888) 491-3243
Hours: 8 a.m. to 5 p.m. Monday through Friday
Gym: 6:30 a.m – 6:30 p.m., Monday through Friday
