Health Clinic
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Main Clinic Number
228-4900
Medical Appointments
228-4971
Pharmacy Refills
228-5260
2960 Tongass Ave 3rd Floor Ketchikan Alaska
Clinic Administration
General Manager-
Debbie Patton
Assistant Health Administrator - Ron Keizer
Medical Director -
Jennifer Bell, MD
Pharmacy Director -
Jeff Eertmoed, RpH
Dental Director -
Elmer Guerrero, DDS
Lab Manager - Beverly Triebert
Interim Nursing/Allied Health Director -
Andre LeCornu, RN
Behavioral Health Director -
Sue Pickrell
Health Information Director -
Ron Keizer
Business Office Director -
Florence Smalley
Contract Health Director -
Ron Keizer
Optometry - Dr. Henry MacPherson
Mission:
"The KIC Tribal Health Clinic in partnership with our patients and with respect for Native cultures, will provide high quality professional services to promote and improve the health of Alaska Natives and American Indians" November 2000
- After hour Triage Number
- Alternate Resources
- Contract Health
- Diabetes Program
- Eligibility
- ER Services
- Excluded Services
- Medevac Services
- Optometry
- Out of State Services
- Patient Escort
- Patient Handbook
- Patient Responsibilities
- Patient Rights
- Pharmacy
- Quality of Care
- Suspension
Ketchikan Indian Community Tribal Health Clinic (KICTHC), through funding from Indian Health Service (IHS), offers comprehensive health services to Alaska Natives and American Indians residing in the Ketchikan Gateway Borough. We provide primary health care services at KICTHC, located at 2960 Tongass Avenue in Ketchikan, Alaska.
Patients are also referred to Ketchikan General Hospital (KGH) in Ketchikan, Mt. Edgecumbe Hospital (MEH) in Sitka, and Alaska Native Medical Center (ANMC) in Anchorage for services authorized by KICTHC.
It is important to understand KICTHC is not an insurance program. Although you have the right to receive health care services wherever you choose, KICTHC will not guarantee payment for this care unless you follow the guidelines outlined in this handbook.
KICTHC provides services to eligible Alaska Natives and American Indians. The level of care provided depends on residency status.
Eligibility Criteria:
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How to access Services
To access services at KICTHC, you must set up a chart by bringing your proof of residency, Native Certification card and any insurance, Medicare/Medicaid cards. You will also need to fill out the new patient registration form. Call the KICTHC Business Office for further information at 228-4900.
Why do we ask for your mailing address and phone number at each visit?
To provide quality health care by ensuring all tests, lab results and other pertinent information is communicated to our patients from the Providers via your mailbox or phone. Please take the time to verify emergency contact information including telephone number (s).
Why do we ask for Insurance information?
The funds KICTHC receives from Indian Health Service do not cover all the costs of the health services we provide. To help pay some of the costs not paid for by Indian Health Service, federal law requires tribes like Ketchikan Indian Community to bill Private insurance companies, Medicare and Medicaid when patients have existing coverage. This additional income makes it possible for KIC Tribal Health Clinic to continue to provide high quality health care.
In the event you require services beyond what is available at KIC THC, your primary provider may refer you for services outside of the clinic. Contract Health Services or (CHS) funds cover the cost for these services. The expenditure of CHS services is based on medical necessity and current funding level.
Examples of CHS expenditures include:
- Expense for Patient/Medical Escort Travel
- Outside Laboratory Testing
- Ketchikan General Hospital:
- npatient Care X-ray Emergency Room
- Laboratory Ultrasound Surgical Consults
- Obstetrical Care Orthopedic Consults
- Specialty Clinic Services:
- Neurology
- Ophthalmology
- Cardiology
- Hepatitis
- Urology
- Orthopedics
- Rheumatoid Arthritis
CHS Referrals
In order for KIC THC to pay for your travel, a KICTHC physician must authoize your referral to the outside providers/hospitals. You will need a CHS authorized referral form for each visit (unless otherwise indicated on the form) to present at the time the service is received. Referral slips can be picked up from the CHS program prior to appointment. r
Self Referrals
If you choose to seek care on your own, outside of the KIC THC system, either within or outside Alaska, our physicians will gladly make the referral. However, KIC THC will not accept any financial responsibility nor will KICTHC be able to assist with payment for travel or the coordination of your insurance and/or Medicare payments to these providers.
Denial of Payment For CHS
Common reasons for KICTHC to deny payment of bills from outside providers are:
No prior notification
No triage or 72-hour notice of an ER visit
No medical record established at KICTHC
No IHS or CHS eligibility on file
Non emergency use of emergency room of ambulance
Service is not available for payment through CHS
Patient is in custody of law enforcement or another State agency
Patient left the hospital against medical advice
Visit occurred as a result of a motor vehicle accident-vehicle insurance must be billed first
You are not eligible for CHS until 180 days expire from the date you began residency in Ketchikan
Alternate resouces must be billed before KICTHC can consider payment
No contract health care agreement on file
APPEAL PROCESS
When KICTHC denies payment, you and the Provider will receive written notification. Notification will include the reason for denial, your appeal rights, and the process to follow in order to initiate an appeal. All appeals must be submitted in writing within 30 days of receipt of denial. Failure to follow the process will result in the appeal being dismissed.
The first level of appeal is reviewed and determined by the KICTHC Staff Utilization Review Committee. The final level of appeal is presented to a three member Appeals Committee and the decision is final and non-appealable.
If you have any questions regarding what services KICTHC can pay, please call the KICTHC Contract Health Services office before you access the service.
Denial of payment and/or appeal will in no way affect medical or dental care provided by KICTHC to you or your family, nor will it affect the payment status of alternate resource coverage (private insurance, Medicare, Medicaid, etc.).
NOTE: KICTHC is presented with many requests for non-KIC patients and for KIC patients who did not intend KIC to pay for services. If you receive a denial for payment of services that you feel should be paid by KIC, follow the appeal process directions. If you choose to file an appeal, bring the denial letter to CHS at KICTHC right away.
The Indian Health Service only funds a portion of the cost to provide health care to IHS beneficiaries. By receiving payments from outside resources, KICTHC is able to provide more and better services for all beneficiaries.
If you are eligible for other health care coverage, such as private insurance, Denali Kid Care, Medicaid or Medicare which help pay for services, you are responsible to apply for those medical benefits which help pay for KICTHC services.
Suspension of Patient Privileges
When the care of other patients and the safety of KICTHC staff are possibly threatened due to a patient’s behavior, clinic restrictions will be enforced. The KICTHC Health Administrator is responsible for determining if such a restriction is needed.
This restriction will usually take the form of a written notice being issued, which suspends the patient’s access to the clinic for 90 days. Other legal action may be undertaken when deemed appropriate.
Emergency
An acute medical need that can only be managed immediately will usually require a visit to a hospital emergency department Determining what constitutes an emergency is first and foremost your responsibility.
Emergency care is defined as:
An acute medical condition, sudden in onset, with severe symptoms posing an immediate threat to life, limb, or organ.
Medical conditions in which a delay in care would be hazardous to life or would result in serious complications are also considered emergencies.
If you are unsure of the significance of your symptoms while experiencing a medical problem, call KICTHC during business hours and our Nursing staff will instruct and direct you to appropriate care. After business hours, call the after hours triage system.
If you determine a true emergency exists or if you are directed to do so by a KIC triage Nurse, proceed to the local emergency department. In the event an ambulance is required, call 911.
If you go to the KGH Emergency Room, identify yourself as a KIC beneficiary. The ER physician will evaluate you.
Guidlines for Emergency Room service
The guidelines listed below apply to every Emergency Room visit and will determine if payment by KICTHC is appropriate.
- Emergency care is necessary based on diagnosis, signs/symptoms, and KICTHC or another IHS facility is not available for services.
- KICTHC is notified of the emergency within 72 hours from the beginning of treatment (this notification can be by the patient or the patient’s family).
You and your family have immediate access to urgent health care advice when you need it most. The after hours telephone triage service is staffed with Nurse consultants using physician approved protocols. If a visit to the Doctor or hospital is appropriate, the Nurse will direct you according to the Doctor's instructions.
Referrals to the ER made through the Triage System does not guarantee payment by KICTHC. Please read the definition of emergency care on page 21 of the Handbook. Contact the KICTHC CHS department or your Primary Care Provider immediately if the emergency room physician refers you to a non-KICTHC Provider for follow-up or non-emergent care, or you may be responsible for the bill.
Should a medical emergency arise while you are traveling outside Alaska, you should seek care from the nearest Indian Health Service facility. If no Indian Health Service facility is available, you must call KICTHC CHS department within 72 hours (three days, including weekends, from the time emergency services began) for payment authorization. Contact the CHS program at (907) 228-4900.
IF YOU MOVE OUTSIDE OF ALASKA
You will remain eligible for emergency medical services for a period of six months if you move out-of-state. You must have Indian Health Service eligibility on file with KICTHC.
STUDENTS AT SCHOOL OUTSIDE ALASKA
If you plan to attend school outside Alaska, you must contact KICTHC Business Office at 228-4900 before leaving. KICTHC will follow the same guidelines for emergent care outside Alaska travel.
Patient Escort and Travel
If you are referred to Mt. Edgecumbe Hospital or Alaska Native Medical Center for care, the CHS travel coordinator will coordinate your appointment dates and times. Once your appointments are set, the patient travel coordinator will arrange authorization and travel. (Medicaid will not authorize travel until the month of the appointment). The patient travel coordinator is happy to answer your questions and address your concerns about travel or stay at Sitka or at Anchorage. If it is close to your appointment date and you have not heard from the patient travel coordinator, it is a good idea to call the CHS program right away.
Airfare
KIC THC provides roundtrip travel for most referred medical services received at MEH in Sitka and ANMC in Anchorage.
Lodging
Unless admitted to the hospital, you are responsible for your lodging. Lodging is usually available at no cost through SEARHC in Sitka. ANMC usually has space available to patients at the Quyana House in Anchorage.
Meals and Transportation
Patients are responsible for their own transportation and meals. If you have Medicaid, please ask the KIC THC patient travel coordinator about obtaining meal and taxi vouchers.
On occasion, patients will require transport using a special air ambulance. These transfers will be determined by medical need. Occasionally, a single-family member or friend may accompany the patient, space permitting.
A wide range of direct care and CHS services are available to you through KICTHC. However, total and comprehensive care of all medical & secondary health needs cannot be provided.
In general, services from outside Providers that are available to patients at KICTHC or another Indian Health Service facility cannot be funded by KICTHC.
Some of the following services are provided on a limited basis at the clinic, but CHS funds are not available to pay for these services from an outside Provider. However, qualifying patients can often have these services paid for by other programs such as state Public Health, Medicare, or Medicaid.
- Allergy testing or treatment
- Audiology services
- Care in an extended care or skilled Nursing facility
- Chiropractic services
- Durable equipment and supplies, purchase or rental (nebulizer, home oxygen, etc.)
- Eyeglasses or contacts
- Hearing screening, fitting and purchase of hearing aides
- HIV Medicine
- Home health care services
- Organ transplantation
- Lodging or meals for patients or non-medical escorts
- Prosthetic devices & Orthotics
- Renal dialysis (chronic)
- Services provided at a non-IHS facility if the need for service could have been reasonably foreseen prior to departure from the area. This includes newborn deliveries
- Speech Therapy
The following services are not available as a direct care or CHS service and are generally not covered by other government programs:
- Abortion
- Alternative Medicine (Acupuncture, homeopathy, etc.)
- Any procedure that can be classified as experimental, investigative, or unusual in Alaska medical practice
- Burial of deceased beneficiary
- Cosmetic surgery or services
- Custodial, domiciliary, or Nursing home care
- Delivery of infants not in a hospital
- Drug testing for employment
- Infertility evaluation or treatment (artificial insemination, reversal of tubal ligation, etc.)
- Physical exam for a pilot’s license
- Plastic surgery for other than re-constructive purposes
- Sex transformation procedures, services and supplies
Patient Comment and Complaint Policy
Patients, family members of patients, and others concerned with the welfare of our patients, have the right to submit complaints, questions or concerns about their quality of care. Issues can be submitted verbally to the person in charge of the patient’s care or to any member KICTHC Administration. It is the intent at the KIC Tribal Health Clinic that patient comments will be dealt with promptly (adhering to HIPPA regulations) and resolved to the mutual satisfaction of all parties.
You can tell your Provider or Nurse. They may be able to correct the situation immediately. In some instances, they may seek assistance from a supervisor, department manager or administrative staff member to address the issue. You may also submit a “Patient Comments/Complaint” form. Blank forms are located at each reception area of the clinic. You are welcome to mail in the form to the address provided or return form to any reception area of the clinic.
The appropriate department manager and the Health Administrator will review your concerns and take any necessary corrective action. You will receive a written or verbal response from KICTHC.
All issues will be reviewed. KICTHC will not discriminate against anyone who submits a complaint in affording access to care in the future.
Your comments are very valuable and help us continuously improve our services to you, so please let us know what you think
Ketchikan Indian Community Tribal Health Clinic Diabetes Program
Mission
To prevent diabetes related conditions and their complications. Emphasis is on nutrition, physical activity, and self-management for basic prevention and aggressive tracking and medical treatment for secondary prevention.
Goals
- To promote and increase the utilization of KIC and community exercise programs, services and equipment;
- To provide education to the community about diabetes risk factors and preventive strategies;
- To maintain or reduce the prevalence of diabetes (T2DM) through early diagnosis and treatment of pre-diabetes and related conditions;
- To increase access and use of physical activity programs, services, and equipment;
- To prevent cases of DM and related conditions through healthier food choices;
- To decrease the risk of diabetes by promotion of breastfeeding
The Special Diabetes Program for Indians (SDPI) has provided diabetes prevention and treatment programs and services in American Indian and Alaska Native (AI/AN) communities since 1998.
KICTHC DM program continues to partner with the Ketchikan Gateway Borough by promoting services and providing KIC tribal members with passes for use of its recreation center and swimming pool. Access and use of the fitness center and pool provide help reduce the risks of diabetes and complications through increasing physical activities.
Eye care is very important to your diabetes care. Diabetes can cause blindness. This is why a dilated eye examination every year is important. If you need eyeglasses the DM program has funding available to assist you in purchasing a pair. You may call KIC Optometry at 228-4910 to schedule your eye exam.
- Funding applies to written eyeglass prescriptions issued by KIC Eye Clinic.
- Funding applies to eyeglasses purchased from Ketchikan Eye Care Center only.
- Funding is limited to $300.
- Funding will not exceed the cost of the eyeglasses.
Dental care is also every important to your diabetes care. Diabetics are twice more likely to have gum disease as the general public. The reasons for this complication are high sugars in the saliva in your mouth. Bacteria will then use this as a good source which creates periodontal disease. I would encourage all diabetic patients to make an appointment for your dental exam at least two times per year. You may call KIC Dental at 228-4915 to schedule your dental screening.
When you have diabetes, proper foot care is very important. Poor foot care with diabetes can lead to serious health problems, including possibly have to remove the foot or leg (amputation). It’s important to understand the connection between diabetes and foot care. As a person with diabetes, you are more vulnerable to foot problems because diabetes can damage your nerves and reduce blood flow to your feet. Therefore proper shoes are very important to healthy feet.
The DM program has funding available to help purchase the proper diabetic shoes for our patients.
The Alaska Area Diabetes Team annual field clinic provide patients with updated education for prevention and care of diabetes related conditions. ANMC brings a podiatrist, nutritionist, pharmacist, medical doctor, and a nurse practitioner so all patients needs and any questions they have about diabetes are met.
As the prevalence of diabetes continues to increase in the Ketchikan patient population, so does the need for comprehensive diabetes care and diabetes self-management education. Studies have shown that patients will gain the advantage offered by good glycemic, hypertension and lipid control and thus a reduction in long-term complications. This continues to be a primary focus of our activities.
For more information on any services that we provide through our Diabetes Program, please feel free to contact:
Marsha Ramirez
228-4955
mramirez@kictribe.org
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KETCHIKAN INDIAN COMMUNITY
The Eye Clinic at Ketchikan Indian Community (KIC) is located on the fourth floor of the Tribal Health Clinic. The Eye Clinic was established in April 2008 to provide for the eye care needs of KIC beneficiaries. The Eye Clinic is staffed by an optometrist and an assistant.
SCOPE OF SERVICES
All aspects of primary care are provided in this Clinic. Appliances such as eyeglasses and contact lenses are not available through this Clinic, nor are non-medical elective services such as contact lens examinations.
Authorized services outside the scope of the KIC Eye Clinic are arranged within the Indian Health Service health care system by the KIC Eye Clinic. Such care is provided during Specialty Eye Clinics, hosted by KIC about twice annually, or through referral to the Alaska Native Medical Clinic (ANMC) in Anchorage. In each case, the fundamental preparation is first provided by the KIC Eye Clinic.
The KIC Eye Clinic now operates approximately one month per calendar quarter, to match utilization by KIC beneficiaries. This is subject to modification according to changes in demand. The goal is to provide routine eye care to every KIC beneficiary desiring or needing it. Routine care is rendered by appointment while urgent conditions coinciding with Eye Clinic sessions are addressed with appropriate timeliness.
PRIORITIES OF CARE
The Priorities of care for the KIC Eye Clinic are to:
• Provide care to infants and pre-school children.
• Provide care to beneficiaries with diabetes.
• Provide care to beneficiaries with ocular disease and systemic diseases having ocular manifestations.
• Provide routine eye care to school-age children.
• Provide routine eye care to adults and other age groups.
OBTAINING EYE CARE
• Routine eye care is arranged in advance, by appointment. Appointments can be made by contacting the Eye Clinic at (907) 228-4910.
OBTAINING EYE GLASSES
• The Eye Clinic at Ketchikan Indian Community will provide written prescriptions for eyeglasses or advise patients if ready made over the counter reading spectacles from the store are best suited to their particular needs.
• Prescription eyeglasses may be obtained from an establishment in the private sector such as Ketchikan Eye Care Center, an optical dispensary elsewhere, or by ordering them on line via the internet.
• Ketchikan Indian Community does not supply eyeglasses nor does it normally furnish funding to assist in purchasing spectacles. Exceptions are (1.) assistance to qualifying beneficiaries through the Dolly Jensen Fund (subject to the availability of funds), and (2.) funding for beneficiaries with diabetes through the KIC Diabetic Program grant. In each of these instances the following applies:
• Funding applies to written eyeglass prescriptions issued by KIC Eye Clinic.
• Funding applies to eyeglasses purchased from Ketchikan Eye Care Center.
• Funding is limited to $200 for single vision spectacles and $300 for bifocals.
• Funding will not exceed the cost of the eyeglasses.
• Funding for eyeglasses will not be furnished more often than once in one year.
• In certain situations assistance in obtaining eyeglasses may be obtained through the following means:
• Medicare will fund the purchase of (only) one pair of spectacles following cataract surgery. This is arranged through an optical dispensary (locally, the Ketchikan Eye Care Center).
• Medicaid will supply one pair of eyeglasses per calendar year to those eligible for Medicaid benefits. These eyeglasses may be obtained from an optical dispensary which participates in the Alaska State Medicaid Program.
Ketchikan Indian Community Tribal Health Clinic Pharmacy
The pharmacy provides full-service outpatient pharmacy operations including: Outpatient Prescriptions, Clinical Consultations, Anticoagulation Clinic and Patient Consultations.
Hours of Operation
The pharmacy is open from 8:30AM-5:00PM Monday thru Friday EXCEPT Wednesday when we are open from 10:00AM-5:00PM.
Phone-In Refills - (907)228-5260
If your provider has authorized refills on your prescription, please call in your refills to our Phone-In Refill Line at 228-5260. Please allow three business days after you call before you expect to pick up your medications – plan ahead and call in early to avoid running out of your medications.
Patient Consultation
A pharmacist is always on duty during business hours and available for consultation if you have any questions regarding your medications including: how to take your medications, side-effects, possible drug interactions, and any other concerns you may have. The pharmacy has private consultation rooms for this purpose and we’ll be happy to sit down with you to discuss your medications.
Days Supply of Chronic Medications
The pharmacy will fill up to a 90-day supply of chronic medications if authorized by your provider with the following exceptions:
Your insurance policy limits the days supply.
Controlled medications (C-II thru V) are limited to a 30-day supply.
Filling Prescriptions from Non-KIC Providers
Please see attached Memo for the current policy on the filling of prescriptions from outside providers.
To Access the After Hours Triage System
Call 1-888-635-3376