Any Pokagon Band citizen who lives within 90 minutes of Pokagon Health Services is invited to register for services and allow PHS to serve as their primary care provider. For Pokagon Band citizens whose needs require a referral for medical services outside the Clinic, certain criteria must be present for them to be eligible for Purchased/Referred Care funding to help pay for those services.
Each patient must update their registration annually during their birthday month. Patients who are updating their eligibility will be given until the last day of their birthday month. If your file is not up-to-date by the last day of your birthday month, your file will transfer to Clinic services only, and you will not be eligible for Purchased/Referred Care until your file is complete and up-to-date.
We will be unable to make PRC payments on your behalf unless your Patient Registration is complete, accurate, and up-to-date on the date of services. Unless the file is updated, health care bills and prescription will not be paid by PRC.
The following must be on file with Health Services before you are PRC eligible:
- The original Registration form signed and dated
- Health Services Agreement signed and on file with the Clinic
- Proof of Guardianship/Custody/Power of Attorney documents when applicable
- A copy of your Tribal Enrollment card or a letter of Enrollment (front & back of the card)
- A copy (front & back) of your Michigan/Indiana Drivers License or a copy of a Michigan/Indiana Picture Identification Card showing your current address. Citizens under the age of 18 must have a copy of their Guardian's Driver's license or State ID
- If you do not have a Driver's License or a State ID we will need one (1) piece of mail with your current address. Tribal and personal mail is not valid.
- A copy of your Insurance card or Medicaid card (front & back) or a written Declaration of an ultimate denial from an alternate resource for payment, such as health/medical insurance, State Medicaid, Federal or other assistance programs
- Medical insurance or Medicaid denial must state why coverage has ended
There is other criteria for children under the age of 18, pregnant women, and patients of behavioral health which may qualify them for full or partial PRC services. Please contact Priscilla Gatties at (269) 462-4403 to discover for what benefits you could be eligible.
- The patient shall notify the Referral Specialist or the PHS Provider prior to provision of medical services.
- Once a referral order is generated for medical services, patients/specialists must provide notification of appointment dates prior to services.
- The patient/patient representative/medical provider shall notify PHS within 72 hours after the initial admission/start of treatment.
- If the patient is 65 years or older or disabled, notification is required within 30 days.
- The patient must make every attempt to use the PHS clinic prior to resorting to walk-in or ER facilities. Using the ER is a last resort and only for cases that are a potential threat to life or limb.
If notification is not received, PRC funds cannot be used to cover the cost of medical care. Referral Specialists will give you a confirmation number once your care has been approved.