Purchase & Referred Care

The Purchased & Referred Care Program will assist eligible patients with payment for health care services provided outside of those offered at the Lummi Tribal Health Center (LTHC). Eligible services are intended to supplement, but not duplicate “direct care services” available at LTHC.

Covered referrals should be made by an LTHC provider and coordinated with the referral specialist.

Any denial of PRC funds, patients must submit an appeal in writing within 30 days and a physical letter must be dropped off at the drop box in front of the clinic.

When referred to a specialty office, if they send you for other services, labs, or x-rays, make sure to request a copy of the order and have them fax it back to the LTHC referral specialist at (360) 384-2334.  This helps communicate to our PRC staff to approve payment for services.

Additional PRC Patient Responsibilities

When referred to services outside of the Lummi Tribal Health Center, patients are responsible for making it to their appointments. Some Doctors/Dentists offices will charge a no-show fee.

1. Patients who miss their appointments are responsible for their no-show fee.
2. Patients are responsible for submitting their own bills to the clinic drop box.
3. Patients are responsible for providing their insurance information to their referred care office. Lummi PRC is added as secondary coverage:

Policy ID: DOB or social security #

Address: 2592 Kwina Rd., Bellingham, WA 98226

Fax: (360) 384-2336

Phone: (360) 384-0464 or (360) 312-2285

PRC Eligibility

PRC benefits are available for enrolled Lummi Tribal members or enrollable Lummi Tribal members less than one year old and living within the boundaries of Whatcom County.

Enrolled members of other federally recognized tribes that live within the boundaries of the Lummi Reservation with an established residency of 90 days minimum, are also eligible for PRC benefits.

Eligible individuals must:

1. Have an active chart at LTHC (charts become inactive after 3 years).
2. Have insurance or apply for health insurance with the help of a Tribal Assister/Benefits Coordinator.
3. Provide proof of enrollment into a US Federally Tribe.
4. Provide proof of residency. *

Additional Eligibility

Special consideration for PRC benefits eligibility outside of the PRC Delivery Area (PRCDA); Whatcom County, is given to additional circumstances that may require more documentation. Eligibility is extended to:

1. Enrolled Lummi Tribal Members attending school outside of the PRCDA; full-time students and their dependents are eligible for PRC benefits during their attendance of vocational, technical, or higher education programs. Eligibility during program vacations, scheduled breaks, or the completion of the program, is maintained for a period not to exceed 180 days. Verification of school attendance is required.
2. An enrolled Lummi Tribal Member who leaves the PRCDA for temporary work or travel will be eligible for PRC for a period not to exceed 180 days from the departure date.
3. Foster Children placed outside of the PRCDA, when health insurance does not cover services medically necessary and it is on Lummi PRC’s inclusion list.

* Proof of Residency

To be eligible for PRC benefits, Lummi Tribal Members must live within the boundary of Whatcom County, Non-Lummi Tribal members must live within the boundaries of the Lummi Reservation. Individual proof of residency is required, children may be listed under the parent(s) or legal guardians provided documentation. The following documents can be used as proof of residency:

1. 1. Property/Income Tax Records
   2. Rental Receipts
   3. Utility Payments
   4. Employment Wage Slips
   5. Lummi Housing Authority Rental Agreement

1. Notarized Residency Affidavit (Provided by Clinic or Healthcare Business Office), if unable to produce one of the documents.
2. Lummi Homeless Population-Mailing address will be the same as what is provided on the health insurance application.

Contact

If you have questions about your PRC eligibility, use the contact form below or reach out to one of our PRC staff.

PRC Policy Manual

Download PRC Policy Manual PDF here.