Billing and Insurance

Purchased / Referred Care

We have options for to assist and ensure our community members are provided affordable care.

The Bad River Health and Wellness Center understands that navigating the world of billing can be a challenge. We are dedicated to providing affordable services and compassionate, patient-focused billing and collection practices. Many of our patients are eligible for assistance with their medical expenses or payment options. We're committed to reducing the financial barriers that can sometimes stand in the way of getting the care you need. If you're concerned about a bill, please reach out—we're here to help you.

Billing

Accepted Methods of Payment

Cash
Check/Money Order
Credit Cards: Visa, MasterCard, Discover, and American Express

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Insurance

Coverage

The Bad River Health and Wellness Center accepts a wide range of insurance plans. Since coverage can vary significantly between carriers, we strongly recommend that you contact your insurance company directly to confirm that our services are in-network and to verify coverage for any scheduled or recommended procedures. As the patient, you are responsible for understanding the exclusions, benefits, co-payments, and deductibles outlined in your plan.

Please be ready to present or confirm your current health insurance information and photo identification at the time of your visit. Co-pays are due on the day of service. If you are uninsured or if your insurance does not cover a service (for example, if it's considered not medically necessary), payment will be required in advance.

Medicare Benefits

Medicare requires that all tests and procedures be supported by a diagnosis to be considered medically necessary. If your provider orders a service that Medicare is not likely to cover, you will be asked to sign an Advance Beneficiary Notice (ABN). This form notifies you that Medicare may not pay for the service and that you will be financially responsible for it.

By signing the ABN, you acknowledge that you understand and agree to proceed with the service, and you will be billed for the cost. If you choose not to receive the service, you will be asked to sign a form confirming your decision.

Common Insurance Terms

Co-pay: A fixed amount you pay for a covered healthcare service after you've paid your deductible. Your co-pay amount is set by your insurance plan and is due at the time of your appointment. Not all plans have a co-pay.
Deductible: The amount you must pay out-of-pocket for covered services before your insurance begins to pay. This amount is determined by your insurance plan and may be different from a co-pay. Not all plans require you to meet your full deductible before they start to cover some expenses.
Coinsurance: Your share of the costs for a covered health service, calculated as a percentage. For example, your insurance might pay 80% of the cost, and you would be responsible for the remaining 20% after you've met your deductible. Not all plans include coinsurance.
In-network: Refers to doctors, hospitals, and other providers who have a contract with your health insurance plan to provide services at a negotiated rate. Using in-network providers generally costs you less.
Out-of-network: Refers to providers who do not have a contract with your insurance plan. Services from these providers are often more expensive because the insurer has not negotiated a lower rate with them.

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Purchased / Referred Care (PRC)

PRC services are Medical, Dental, Behavioral Health, Pharmacy, and Optical services that cannot be provided on-site through the Bad River Health and Wellness Center. The need for PRC services must be determined by your Primary Care or Behavioral Health Provider at the Bad River Health and Wellness Center. Your Provider may issue a referral for outside services and PRC will determine your eligibility. Per Federal Regulations, PRC funds are to be used only after all the other sources ( such as private insurance, medical assistance, Medicare, etc..) have paid.

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Eligibility Criteria

ANY person who is a Member or Descendent of a Federally Recognized Tribe living within the Bad River Contract Health Service Delivery Area (CHSDA).
Service Area: Ashland or Iron County
Students: full time students (vocational, technical, academic) are eligible with proper documentation
Patients with NO insurance or expired insurance will need to be screened by the Medical Benefit Specialist to determine eligibility for alternate resources;
Questions about Alternate Resources? Contact the Medical Benefit Specialist Karri Bigboy @ 715682-7133 ext. 4812

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Patient Responsibilities

All Referrals must receive prior approval.
Submit a PRC application and required documentation annually.
Notify PRC within 72 hours after seeking emergency room care. Elders 55+ have 30 days to notify PRC.
Apply for alternate payer resources if you are eligible, prior to scheduled service.
Respond to your Insurance carrier if they request additional information.
Take note of the number of approved visits on your referral form. If more visits are needed, contact your Bad River Health and Wellness Center health care provider.
Contact the Bad River Health and Wellness Center if you have changed your contact information
Bring all bills associated with the visit, to the PRC team as soon as you receive them.

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Emergency Situations

For after hour Urgent or Severe medical problems go directly to the hospital. Notify PRC within 72 hours. Elders age 55+ are allowed 30 days.
After hour prescriptions must be filled at Huhn or Walgreens Pharmacy (Ashland WI). No controlled substances will be authorized. Provide all insurance information to the pharmacy. You will be required to provide Identification.
When seeking emergency care outside of Ashland or Iron County. Follow the same guidelines as above. Be sure to obtain the name, address, and phone number of the hospital where care was provided.

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