Referrals to Outside Providers
Referrals are made when the needed care is
beyond what we have available here at the Health Centers. The
provider will begin the referral process and then arrangements
will be made through the referral nurse.
- Referrals for Contract Health Services must be authorized at
the Health Center by the appropriate health care provider. The
provider may be a physician, dentist, optometrist,
ophthalmologist, mental health or substance abuse counselor.
- Alternate sources for payment must be identified at the time of
referral. (Medicaid, Medicare, or Private Insurance)
- The referral will then be electronically generated and
assigned a unique number and will be placed at patient
registration desk for patient to pick up.
- Lack of compliance with SNI policy by the patient may
result in cancelation of unused referral after 45 days.
- Authorizations are valid for one visit only. If the outside
provider requests follow-up treatment, you will need another
authorized SNHS referral. Referrals must be requested by the
patient 5 business days prior to the appointment. Failure to get another referral may
result in denial of payment of your outside charges.
- Missed appointments will need to be rescheduled by the
patient with notification to a referral nurse within 7 days
or referral may be cancelled.
- If you choose to use services of an outside provider, without
being referred by a provider of the Seneca Nation Health
Department, you will be responsible for the costs. Outside
services are paid through referral only.
After Your Visit Outside the Health Center
(Contract Health eligible patients only)
Occasionally, the patient may receive a bill from a an outside provider for
specialist visits, such as, x-ray, hospital outpatient procedures, emergency
room visits and hospitalizations. In order to notify the outside provider to
submit the claim to the Contract Health Services Unit at the Seneca Nation
Health Department for payment processing, the billing statement must be
presented to Contract Health Services as soon as it is received. This can be
done by bringing the bill into the appropriate Health Center where the
receptionist will help you route the bill to the correct office.