This website is still under construction. Please stay tuned for further updates and features.

Purchase/Referred Care (PRC)

Through PRC, the Siletz Tribe can buy services that are unavailable at the Siletz Clinic or other IHS facilities. Please read the Purchase/Referred Care (PRC) Users Guide for a list of situations where PRC would be used, eligibility requirements and more.

Hours

Monday through Thursday
8:00 AM – 4:30 PM

Friday
9:00 AM – 4:30 PM

Contact

Pre-authorization and notification within 72 hours is required.

541-444-1236
800-628-5720
Fax: 541-444-9645

Emergency Room Gatekeeper

During regular business hours, call the Siletz Clinic. After regular business hours, on weekends, or holidays please call the above number. You will be directed to the answering service, the physician on call will be alerted.

Staff

Selina Rilatos

PRC Tech I

Joell Strong

PRC Tech II

Tasha Rilatos

PRC Tech II

Christine Knott

PRC Tech II

Alternate Healthcare Benefits

The Tribal Council may allocate excess pledge revenue for health benefits.    These benefits are for enrolled Tribal members.  To qualify, Tribal members must be registered for health care with the Siletz Tribal Health Department and complete a Registration Update annually. The alternate healthcare benefits are administered quarterly and are available as long as sufficient funding is available. A member is eligible to choose 1 benefit per quarter of either massage therapy, chiropractic care, or acupuncture. The Alternate Healthcare program will pay for up to 3 visits within the quarter at up to $75.00 per visit. All services must be performed within the same quarter as the authorization was given. Any service performed outside of the authorized quarter may not be eligible for payment under the same authorization and would require a new authorization to be eligible for payment.

The benefits that are available are acupuncture, chiropractic care, and massage therapy. These benefits are available 4 times per year at the beginning of each quarter as long as funding is available. It is on a first come, first served basis. A tribal member just needs to contact PRC and request one benefit they would like.

Dental Services are Eligible for PRC Payment Even if You Live Near the Siletz Clinic or an I.H.S. Facility

PRC-eligible patients (tribal members, dependents, pregnancy) living within 40-miles of the Siletz clinic or an I.H.S. facility are now eligible to obtain services at an outside dental facility.   Due to safety measures taken in response to Covid-19, the Siletz dental department operates a reduced schedule, which impacts the ability to serve all tribal members wanting oral care.   PRC eligible services will be the same types of services you would be eligible for at the Siletz clinic or another I.H.S. facility.  You do not need a referral, but you will need to call PRC for an authorization number.

If you are unsure if specific dental services will be paid, please contact PRC.

Newly Available Services – PRC Funding for Specialty Surgery

Tribal Council approved funding for medically necessary surgeries that are not currently approved services.  To qualify you must be an enrolled Siletz tribal member AND PRC eligible.

Eligible Surgeries:

  • Excess eyelid skin removal
  • Breast reduction
  • Excess abdominal skin removal

PRC will process requests through Gatekeepers; funding is limited and will be first come/first serve.  The established medically necessary criteria is consistent with CMS and insurance guidelines.  Requests deemed as cosmetic will not qualify.    

Dental Services and Funding

PRC-eligible patients living within 40-miles of the Siletz clinic or an I.H.S. facility are now eligible to obtain services at an outside dental facility.  You may also be eligible for implant(s) as the result of reduced access to dental care from dental office closures or reduced capacities.  Implant requests go through Gatekeepers to determine eligibility.   

Out-of-Area tribal members are eligible for an additional benefit of $3,000 for dental services.  Services must be received by 12/31/21.  Please call PRC during regular business hours to secure funding.  Funding is limited.  

Please contact PRC for additional information.

2021 Out of Area Benefits

The Tribal Council has approved Out of Area Benefits for 2021.  These benefits are for Tribal Members who live outside the 11 county service area.  To qualify, Tribal Members must be registered for health care with the Siletz Community Health Clinic and reside outside of the Tribe’s 11 county service area.  These funds are intended for Tribal Members who are not eligible for Purchased/Referred Care.

All Benefits are Dependent on Available Funding:

Annually Biannually

$2000 Total in Medical + Mental Health + Dental + Hearing

Plus $500 Pharmacy Card Benefit

$450 in total Vision Care for Adults*

*available annually for Elders, Children, Students or People with Diabetes

 

Prior authorization by PRC is required, and benefits must be used within 90 days. Any funds not used within 90 days, or claims not received, will be returned to the pool for redistribution.  All benefits are subject to funding availability.  When calling for pre-authorization PRC will authorize for household members only, and voice messages do not hold funds, the individual must speak to PRC Staff and obtain an Out of Area (OOA) number to secure funds.  An individual may access benefits up to $2,000 annually for both Medical/Dental by calling on the authorization date.  For example, an individual may call in January for medical of $500 and then call again in October for dental of $1,500 for a total of $2,000.  All benefits are subject to funding availability.  When calling for pre-authorization PRC will authorize for household members only, and voice messages do not hold funds, the individual must speak to PRC Staff and obtain an Out of Area (OOA) number to secure funds.

To Apply

Call PRC at 800-628-5720.

Call-In Dates

April 1st and July 1st and October 1st.

Please send claims with W-9 via fax to 541-444-9645 or to:

SCHC
Attn: Siletz Purchased/Referred Care
PO Box 320
Siletz, OR 97380

Caremark (Pequot) Pharmacy Card & Reimbursement Information

Regardless of where you live, your pharmacy benefit is $500.00 per year. Every January 1st your card renews. Members that live in the 11-County Service Area should have your maintenance medication mailed to you through the Siletz Community Health Clinic (SCHC) pharmacy. Not all medications are in the SCHC formulary, so that is when you would use you pharmacy card at a retail pharmacy such as; Walgreens, Fred Meyer, Rite Aid etc…

Members that live outside the 11-County Service Area (Direct Care) are not able to get medication mailed through the Siletz clinic, but are able to get medication directly through Pequot Pharmacy. Any maintenance medication needed by Direct Care patients should be mailed to Pequot directly this will stretch your card dollars.

Patients that have primary pharmacy insurance, such as: Medicaid, Blue Cross Blue Shield, AETNA, Medicare Part D etc… and have to pay a co-pay up front to the retail pharmacy, can be reimbursed up to the $500.00 per year. Members that pay up front for medication, and still have a balance on their pharmacy card, can be reimbursed as well.

To receive a reimbursement you must provide the receipt from the pharmacy, not the cash register receipt. The receipt must have:

  • Your Name
  • Dr. Name
  • Date of Service
  • Medication Name
  • Medication Dosage
  • Amount Paid

Mail your receipt to:

Purchased Referred Care
PO Box 320
Siletz, OR 97380

Your pharmacy card should not have you social security number on it. If the card has your social security number on it, then you need to contact PRC at 1-800-628-5720 to get a new card. You will be required to have an updated Individual Registration form on file in order to receive your new card.

Mental Health Services

Services Available

  • Counseling Services – individual or family
  • Psychiatry Services
  • Psychology Services
  • Up to 8-visits annually (more if medically necessary)

Eligibility

Siletz Tribal Members are eligible for Purchased/Referred Care (PRC), formerly Contract Health Services (CHS).

How to Get Benefits

Call PRC at 800-628-5720. Prior to making an appointment with a provider, confirm the provider will accept PRC as payment. Benefits are limited and on a first-come, first-serve basis.

What You Need to Know

After calling PRC for benefits, the patient will receive a letter with program details. The letter also provides information that the patient can give to their provider for payment processing information.

You will not be required to use other resources first. This will allow you to go to a provider that does not accept Oregon Health Plan/Medicaid or your private insurance.