Hospital Visits
Purchased/Referred Care Services - Eligible Patients
Upon registration at the hospital, you will be asked for insurance information. You should notify the hospital, not only of your health insurance/Medicare/Medicaid, but also of your eligibility for coverage through the Seneca Nation Health System. The SNHS is always the payor of last resort, which means that we will cover what your insurance company does not. Part of your eligibility requirements for this coverage is that you must try to seek a separate form of coverage other than relying solely on the Seneca Nation Health System and Indian Health Services for payment. Please see a Patient Benefits Specialist at your local Health Center for assistance in meeting these requirements.
Emergency Room or Hospitalization
Emergency room treatment or hospitalization is the only exception to the advance authorization requirements. The patient must, however, notify the Medical Unit at their local Health Center within 72 hours (3 days) after receipt of emergency room or urgent care services. Also, after release, a copy of the patients discharge form must be turned into the health center.
The patient will need to sign a "Release of Information" form so that copies of his/her medical information may be obtained by the Health Center. Failure to do so will complicate the handling of these charges and may result in denial of payment.
Pharmacy Services after Urgent Care, Emergency Room or Hospital Discharge
With the closure of the local Rite Aid Pharmacies, please follow the guidelines below if you need to get a prescription when the SNHS Pharmacies are not open (in general, emergency supply of regular medications or new medications from ER/urgent care/hospital only). Note: our current operating hours are Monday thru Friday 7:30 am to 6 pm.
- Take your prescription to the pharmacy of your choice.
- Just get enough of the medication until our pharmacy opens, for example we cannot reimburse/cover 30-day supplies.
- Ask the outside pharmacy to run the prescription through your insurance.
- Pay for the prescription and get a receipt (both pharmacy and cash register receipt).
- Bring the receipts to the SNHS pharmacy to start the reimbursement process.
- Please contact your SNHS pharmacy with any questions.
- Pharmacy after hours policies must be followed or reimbursement will be denied- ER, urgent care and hospital discharges must be reported within 72 hours.
Receiving A Bill After Service
Occasionally, the patient may receive a bill from services rendered outside of the Health Center. In order to notify the outside provider to submit the claim to the SNHS Purchased/Referred Care Services for payment processing, the billing statement must be presented to PRC as soon as it is received. If you are eligible for Purchased/Referred Care Services and receive a bill, please drop it off at your local Health Center for processing.
If you have any further questions regarding eligibility, patient rights and responsibility, Purchased/Referred Care Services, or referrals, see the informational links in the Patient Information tab or call your Health Center.
