No more ‘life or limb’ criteria
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Editor,
I hear many, many horror stories how the Tribal Health keeps turning down medical care for those who are eligible; such denials are for surgeries, procedures and doctor referrals.
The United States Treaty states “all members of the Salish Kootenai and Pend d’Oreille tribes that reside within the interior boundaries of the reservation shall receive free medical care.”
So why is the treaty being broken? And you may want to ask yourself, by whose authority? Is it our very own Tribal Health representatives?
For years the Tribal Health has been at an operating emergency level of: only if you are about to lose your life or a limb. That is what they have in place for our coverage.
Mr. Howlett stated that our children are our future; well that is a fact, we don’t need a Harvard degree to acknowledge this. Our Elders are the present, past, and the future. Without them we would have no direction, wisdom, courage, patience, etc. All tribal enrolled members and descendents are just as important to this Tribe.
Recently I appealed a medical emergency room bill that had been denied by Contract Care. They said it wasn’t a priority, after proving that it fit the criteria for a medical priority. They sent me another letter stating that they agreed that the medical care was necessary, and that decision to deny payment was appropriate based on Federal Regulations CFR 36.23 (e): which states, “when funds are insufficient to provide the volume of contract health services indicated as needed by the population residing in the contract health care area priorities for services shall be determined on the basis of relative medical need,” and CFR 36.24b (1), which requires notification within 72 hours of treatment.
My next appeal has already gone out to the Rockville, Maryland office. Fight for what you believe in. If you don’t, pretty soon we won’t be able to tell the living from the dead if Tribal Health continues to operate in this inhumane manner.
Sharlene Peone
Pablo
