Managed Care Program

About Managed Care Program

The Warm Springs Health & Wellness Center provides comprehensive direct health care services for the tribal members, other federally recognized Indian tribes and other appropriate segments of the local population. Contract Health is provided to those living on the reservation or designated catchment area and is paid by the Managed Care Program operated by the Confederated Tribes.

Podiatry, Phematology, Cardiology, ENT, Pediatric Nephrology, oral surgery and Endodontia services are also provided. Ancillary support classes in nutrition, healthy cooking and exercise programs are provided to all patients.

The program provides mental health, substance abuse, WIC, MCH, Home Health, Physical Therapy, and Healthy Kid’s Program services to these same patients. The total patient population is approximately 5,750 annually.

Mission

Helps facilitate Doctor appointments outside Warm Springs clinic. Pays for that service provided. Pays for ER and Inpatient stays in hospital.

Who is Eligible?

Tribal members living in CHISDA, Non Tribal members living on the Reservation.

Commonly Asked Questions

What do you cover? Doctor appointments outside the clinic that doctors inside the clinic have ordered.

Who makes my appointment? Medical is suppose to makes appointments for patients.

Why do I need on OMAP? It is a IHS regulation to be on an insurance that is free.

Do you pay for pharmacy? No-Offered at IHS

Do you pay for dental? No-Offered at IHS

Do you pay for psychiatry? No- Offered at Tribal

Do I have to be on Healthcomp? No- MCP can not ask anyone to take out coverage that cost that patient money.

How long does a referral last? Generally 3 months. A referral is not made to turn care over to another doctor totally.

Am I eligible for MCP? Call the MCP program and ask any time.

Which providers can I go to with DMAP? Ask MCP and they will look up or ask a provider if they take it.

Will you pay for glasses? Elder, diabetic and students only.

Where do I get a referral for gas voucher? At Medical Records. It’s a legal document that is protected under HIPPA.

What do I do if I get a bill in the mail? Bring it into MCP, and we will research and call for it if you went through the system and got a referral to go out for treatment.

Why do I get a bill? Bills will always customarily go to the patient’s home. MCP can not stop that from happening. Bring the bill into MCP.

How do I become MCP? Come into WSHWC and bring proof of Indian Blood and register with clinic. Have to be Direct Only first then MCP eligibility will be determined by Patient Advocate. It is your responsibility to prove you are living on Reservation not the Patient Advocate. Need physical address only, not PO Box, on a light bill or rental statement.

If I move back to Reservation after being away for some time, is it automatic that I am MCP eligible? No, you must come into the clinic and update your file with IHS and re-establish your eligibility because MCP does not retro back. If you move back to Reservation take the time to come in and get your file in order in case of emergency.

 

Location / Driving Directions

Google pages for Warm Springs Managed Care Program
Google images for Warm Springs Managed Care Program