Benefits plan, new and improved

SUIT

The Southern Ute Tribal Health Department has made one change to the Tribal Member Health Benefits plan, the department has partnered with a new third party administrator (TPA). This new TPA will be responsible for tracking medical claims and ensuring the timely payments for providers. Forrest County Potawatomi Insurance Department (FCPID) has taken over as the new administrator, they are known for specializing in administrative services for Tribal nations across Indian Country.

FCPID is an insurance department that works with tribal entities and according to their mission statement are, “Dedicated to providing superior customer service and innovative services.” FCIPD will advocate for the Southern Ute Tribe’s health care in a professional and traditional manner.

Currently the Tribal Member Health Benefits plan pays medical claims for members, the recent TPA change will not affect coverage. It covers most services that the membership receives outside of the Southern Ute Health Center. The plan is similar to the health insurance provided to employees, but is still not an insurance plan. “Nothing has been taken away,” Southern Ute Tribal Health Benefits Coordinator, Erika Atencio stated. “We just want to see members get the care they need.”

The membership will still have access to the Southern Ute Health Center to use as their primary care. For members who live off reservation, they will still be able to use the Southern Ute Tribal Health Department to help coordinate a location of primary care by using the referral programs for services.

By using FCIPD, the Southern Ute Indian Tribe will be saving on costs. Now, the medical claims processing will be easier, the Tribe will receive “Medicare-like” rates for claims, and the customer service is expected to be simpler than ever. FCIPD provides a significantly discounted repricing of medical claims. They have the ability to work with the providers one on one and offer their expertise of administrative services that is specific to tribes. Not only are they looking out for the Tribe’s health care, but they are also focused on using federal resources to help minimize the use of tribal dollars to fund health care claims.

If your provider has questions about anything, they are encouraged to call FCIPD who will explain the new change to them. The health card will show the correct and necessary information of coverage; the card can be presented to any doctor, hospital, clinic or urgent care that the tribal member sees for care. The card is also a way for the service providers to see who the contracted TPA is.

FCIPD will be responsible for receiving medical claims from providers and will ensure that the bills are paid on time.

There are no changes to the vision and dental coverage. Prescriptions and medications will not be impacted by this change either. Nothing other than the new TPA has changed.

Tribal Members will have more options than ever to choose their own provider because Anthem Blue Cross Blue Shield is no longer in place. This means that the “In/Out of Network” is no longer active; you can go wherever you want for medical services. Out of state coverage is still covered, current providers can still be seen and FCIPD will take care of your medical claims/bills.

If a tribal member is enrolled or enrolls in the Southern Ute Indian Tribe Employee Health Plan, they are responsible for paying for said level of coverage, but the Southern Ute Tribal Health Department will reimburse that amount and for any additional costs (such as co-pays) for all enrolled tribal members and dependents. This does not cover non-Southern Ute family members or dependents, same as the previous benefit plan.

Tribal members should expect to see a new Health Benefits Card in the mail as this change was made effective Sunday, Sept. 1, 2019, if you have not received your card yet contact the Tribal Health Department. To better understand this change or for any remaining questions you may have about the Tribal Member Health Benefits Plan, contact the Tribal Health Department at 970.563.4742

 

 

 

 

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