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Purchased & Referred Care

Purchased and Referred Care are additional services offered, such as the list below, although not directly provided within KANA facilities. Before KANA will purchase or refer care, patients must first meet with a KANA provider to discuss authorization or referral. 

 

Who qualifies for Purchased and Referred Care?

 

In order to qualify for Purchased and Referred Care you must provide proof of residency in Kodiak for at least 90 days, be an Alaskan Native enrolled in a federally recognized tribe or the descendant of a member of a federally recognized tribe, be the pregnant mother of a child that is eligible for contract services, or be an adopted step or foster child who is a dependent of at least 1 eligible beneficiary (up to 19 years of age).

Services Purchased and Referred Care Covers:

  • Authorized Emergent ER Visits
  • Emergent Ambulance Transports
  • Eye injury related visits  
  • CT Scans
  • Labs
  • Mammograms
  • Surgical Consults
  • Physical Therapy (patients must have a referral from a provider, visits are limited)
  • Treadmill Tests
  • X-Rays
  • Travel costs for urgent/emergent services
  • Ultrasounds

 

What is the Emergency Room Policy? 

 

KANA receives limited funding to purchase emergency room services and authorizes payment only for the treatment of true medical emergencies. Patients will be financially responsible for any charges that are not authorized by KANA or do not meet the definition of a medical emergency. Patients experiencing symptoms of a true medical emergency should proceed directly to the emergency room or call 911 immediately. Do not call the hospital for prior authorization.

A medical emergency exists when there is a sudden, unexpected, life-threatening or potentially disabling condition that requires medical intervention within hours or minutes that if left untreated until regular clinic hours would result in loss of life, loss of limb, or serious impairment to bodily function. Please call 486-9828 within 72 hours to report ER usage. 

Non-emergent situations should could have been treated at KANA facilities during regular clinic hours, including Saturday hours (9:00am - 2:00pm) at the Mill Bay Health Center.The following are some common examples of conditions that DO NOT meet the definition of a medical emergency:

  • Minor problems - colds, sore throat, earache, stomachache, etc
  • Diagnosed anxiety or other chronic conditions
  • Minor or chronic headache symptoms including migraines that are being treated
  • Muscle aches/pain
  • Behavioral Health or Alcohol/Drug Treatment
  • Alcohol Intoxication/Substance Abuse
  • Small cuts/abrasions requiring minor first aid
  • Management of chronic health conditions
  • Prescription refills
  • Chronic pain - back pain, neck pain, etc.
  • Injuries sustained while committing a crime or caused by self-destructive behavior
  • Services Received while in custody of law enforcement

 

Village Residents should contact your village Community Health Aide for all life-threatening conditions. If a Community Health Aide is not available, contact the United States Coast Guard (1-800-478-5555) to report the emergency and request medevac. Please contact the CHA during regular business hours to schedule an appointment for all non-emergent conditions. Please call 486-9828 within 72 hours to report ER usage. 

 
Why do I need to apply for Alternative Resources?

 

KANA is considered a “Payer of Last Resort” according to federal regulations. Beneficiaries are urged to make a “good faith” effort to apply for alternative resources before requesting KANA to use Purchased and Referred funds. Funds will not be authorized if you are eligible for, and have not applied for, alternative health resources such as:

  • Medicaid
  • Medicare
  • Denali Kid Care
  • Fisherman's Fund
  • Workman's Compensation
  • Other Resources

If you have made an effort to apply for the programs, and have been denied, then KANA will use Purchased and Referred Care funds. The reason for this is because Purchased and Referred Care funds are limited and we want to ensure that KANA's Purchased and Referred Care funds can help as many beneficiaries as possible who do not have alternative options.