Qualifying for Service
Who is eligible to travel for medical services?
Alaska Natives and American Indians who are Alaska residents for the prior 180 days and who intend to remain in Alaska indefinitely
Alaska Natives and American Indians who meet SEARHC's eligibility policy requirements
Non-Indian women who are pregnant with an eligible Alaska Native or American Indian man's child. American Indian man's child up to six weeks post partum
Children of an eligible Alaska Native or American Indian, including non-Indian foster children, adopted children, stepchildren, legal wards or orphans, until they reach the age of 19
What is not covered by SEARHC the Community Resources Program?
Medical services provided by a non-tribal facility or provider that has not been authorized by the Community Resources Program
Medical services provided by a non-SEARHC health care provider that have not been referred by a SEARHC physician and authorized by the Community Resources Program case management
Obstetric deliveries at non-tribal hospitals, unless a life-threatening emergency
Inpatient or outpatient mental health services
Inpatient or outpatient substance abuse treatment programs
Medical care considered investigational or experimental
Nursing home or long-term care facilities
Routine dental services
The Community Resources Program will not authorize payment for a non-tribal facility if a tribal health facility was open and available to provide the needed care
This is not an all-inclusive list. Please contact your Community Resources Program case management nurse or the Community Resources Program about coverage, if you have any questions
Starting the Process
How do I start the process to travel for healthcare?
A SEARHC physician must initiate all referrals for medical care
A referral does not mean automatic coverage. When the patient is referred outside, the Community Resources Program must approve medical care. This gives SEARHC an opportunity to notify patients if there will be uncovered expenses and to discuss treatment options.
What is the referral process?
A SEARHC physician must initiate all referrals for medical care
The patient must have eligibility on file at SEARHC
Patients will be required to apply for Medicaid, if they are eligible. If the patient does not successfully complete the Medicaid application process, payment for routine medical services and travel may be denied by the SEARHC Community Resources Program
Why do I need a referral?
If it is not an emergency, authorization is required before treatment is started in order for SEARHC to cover the cost of outside medical care. If you make appointments without consulting a doctor and SEARHC Community Resources Program, we may not be able to help cover your costs.
Can I go to any medical facility of my choice?
All IHS facilities must be utilized instead of private facilities.
I've received an appointment letter. What should I do to ensure that my travel is done in a timely manner?
If you get an appointment letter or phone call with notice of appointments please call your clinic to see if they received your appointments if not you may want to bring it in or fax in your appointment letter.
I know I have appointments why do I need an appointment letter?
Medicaid requires that you get referred in order to travel. If you arranged for healthcare outside of the SEARHC system yourself, then your travel may not be covered. An appointment letter confirms that a referrel has been made, the provider who made it, and which provider outside of SEARHC you will be visiting. The lack of an appointment letter will slow the processing of your request.
Medicaid, Medicare, and Other Alternative Funding
Do I have to apply for alternate funding?
Patients who receive SEARHC Community Resources Program Services funding are required to make a good faith effort to apply for alternate resources, such as Medicaid or Medicare, before Community Resources Program funding can be paid, as SEARHC is the payor of last resort under federal regulation 42 CFR 36.61. Failure for you to make a good faith effort in completing the application process will make you financially responsible for all medical fees incurred outside of our SEARHC facility.
Can SEARHC help me apply for alternate funding?
SEARHC registration staff located at Mt. Edgecumbe Hospital or in any SEARHC facility will be happy to help you apply for appropriate alternative resources.
Why do I need to apply for medicaid if I am a beneficiary?
IHS funds are the payer of last resort, so if your are eligible, you have to apply for medicaid. SEARHC will only authorize patient travel after applying for medicaid.
If patients know they are over income, they need to provide the Community Resources Program with three months worth of pay stubs for all people working in the household.
Medicaid wants me to fly to and from my appointment on the same day I have my appointment. Can I change this?
If US Travel can fly you to your appointments and back on the same day, they will. If you ask to stay longer, a letter of medical necessity will have to be obtained and reviewed.
What is a letter of medical necessity and why is Medicaid asking for it?
A letter of medical necessity is a letter from your primary care provider explaining any special circumstances you may have. If our travel office asks Medicaid to pay for you to travel a day early or with an escort, Medicaid may want this type of document.
How long does it take to do Medicaid Travel?
On average it can take a few hours to complete. If a letter of medical necessity is requested it could take several days. As soon as your medical appointments are made, contact your local medicaid travel office so that the process can be started.
How can I be covered for emergency care while I am outside of Alaska?
You must notify the Community Resources Program in Sitka within 72 hours after you begin medical treatment, including weekends and holidays (leave voicemail), at (866)966-8316.
If you are 65 or older or are disabled, you have 30 days to contact the Community Resources Program
If you are unable to, a relative, friend or health care provider can notify CHC Services on your behalf.
Notifying SEARHC is ultimately your responsibility
Medical emergency coverage is provided for:
People moving outside of Alaska (180 days maximum)
In the event of a medical emergency, the Community Resources Program may require proof of when you left Alaska. This proof could be dated airline tickets, airline boarding passes, ferry tickets or gas receipts if you drove to your destination. For individuals moving outside of Alaska, you should register with the closest Indian Health Service or tribal health facility, if available.
I had to go to the doctor while I was on vacation. How do I get these bills paid?
You have 72 hours from the time services were rendered to call 877-966-8316. ll claims will be reviewed and payment is not guaranteed. If you are over 65, you have 30 days to report services.
Information for Students
See our webpage about medical coverage for students
Services in Southeast Alaska Cities Without a SEARHC Clinic
Can I have SEARHC cover medical services in Metlakatla or Ketchikan?
Ketchikan General should cover ER visits KIC clinic should cover all services. Patient should always ask questions as KIC and MET have different rules.
Most IHS facilities begin coverage after 180 days in the state of Alaska but both Metlakatla and Ketchikan specifically require you to live in their service area for 180 days.
I got medical service in Metlakatla or Ketchikan and got a bill. Does SEARHC pay for this?
No, if one IHS facility denies a bill, another can not make payment so it is always best to call your local Community Resources Program office before you render services. Otherwise, you may be responsible for the bill.