Yoeme Health Plan

An important historical event took place on Thursday, September 30, 2010. In a special Tribal Council meeting Chairman Peter Yucupicio signed the new contract with Indian Health Services, to take over what was formerly called the Yaqui Health Plan. The plan will now be known as the Yoeme Health Plan. The Tribal Council, Executive Health Director, and Health Department staffs all worked tremendously hard to prepare for this exciting change. Many hours were put into the planning, assumption and now, the implementation of the new Yoeme Health Plan. We are very excited about implementing the plan because the tribe will now be able to fully manage all the aspects of our health care plan and medical services delivered to enrolled tribal members living in Pima County.

Very little will change -- El Rio Health Clinic will continue to provide health care services. Improvements, such as a new ID card, access to urgent care services through Next Care Urgent Care centers, and soon a 24-hour pharmacy will help to meet our tribal members' needs. The Tribe’s newly established Yoeme Health Plan Office will manage all referrals and claims, although the process (and the employees involved) will not change much. 

   Many months of planning and reviewing of policies and procedures took place in preparation for assuming the health plan. Over 200 health care providers were invited to attend the first provider meeting that was held at the Desert Diamond Hotel and Conference Center on September 3, 2010. Letters were also sent to over 200 providers requesting that they allow us to contract medical services with them. Currently we have over 75 contracts and are still going strong in making contacts to get other providers on board with the Yoeme Health Plan.

The following information is for all tribal members residing in Pima County:

Regular health care services will continue to be provided at all El Rio Health Centers. Tribal members will be required to apply for alternate resources such as AHCCCS and Medicare. Your medical service provider will not change.

El Rio Health Centers will continue to provide health care services to Yaqui Tribal members who live in Pima County, and who have no other resources.

El Rio will be mailing out new ID cards after October 1st, 2010.

Tribal members will still be required to apply for alternate resources such as AHCCCS, Medicare or the American Indian Health Plan (under AHCCCSS).

NextCare Urgent Care visits will be covered only when referred by El Rio same day or after hours on weekends and holidays.

You MUST contact the Yoeme Health Plan at 520-879-6380 within 72 hours of your visit to the Next Care Urgent Care, the Emergency room or if you have been transported by ambulance or your claim may be denied.

If you have any changes to your address, marital status or added any family members please update your information with El Rio’s Benefit Coordinators immediately.

 

The following information is for all tribal members residing in Pima County:

Regular health care services will continue to be provided at all El Rio Health Centers. Tribal members will be required to apply for alternate resources such as AHCCCS and Medicare. Your medical service provider will not change.

El Rio Health Centers will continue to provide health care services to Yaqui Tribal members who live in Pima County, and who have no other resources.

El Rio will be mailing out new ID cards after October 1st, 2010.

Tribal members will still be required to apply for alternate resources such as AHCCCS, Medicare or the American Indian Health Plan (under AHCCCSS).

NextCare Urgent Care visits will be covered only when referred by El Rio

 

When to use next care Urgent care services

NextCare Urgent Care should only be used

After regular El Rio Clinic hours, on weekends and holidays, or when referred by El Rio Clinic during business hours.

For Non-Life threatening injuries and illnesses in adults and children,

When you can’t get a same-day appointment at El Rio Clinic and you need health care services quickly.

nextcare Urgent care Offers:
Experienced, board-certified medical providers and compassionate care when you can’t get a same day appointment.
Reliable, cost-effective alternatives to the emergency room.
On-line Check-in and wait at home or office (WAHOO! TM) convenience.
Select vaccines, seasonal flu shots, physicals, digital X-Rays and lab services.
On-Site, limited prescription dispensing in most locations. Refills must be coordinated with your El Rio health care provider.
Open M-F 8 AM to 8 PM, Saturday-Sunday and Holidays 8 AM to 4 PM.

WHEN TO USE THE EMERGENCY ROOM:

If you are experiencing any of these conditions, please call 9-1-1- Immediately.

Life-threatening Conditions

Heart Attack or Stroke

Open Fractures

Severe Bleeding

Chest Pain

Head Injury or Other Major Trauma

One-sided Weakness or Numbness

Loss of Consciousness

Severe Abdominal Pain

Please bring any discharge papers to your next El Rio doctor visits

"NOTICE: For Tribal Members Enrolled under AHCCCS:

 

AHCCCS has notified it's providers that patients can be charged co-payments; in some cases you may be denied health care UNLESS you pay the co-payment at time of service. As a result we are advising our Tribal members to change their AHCCCS Plan to the American Indian Health Plan (AIHP). This plan offers tribal members the benefit to be seen by any provider who accepts this plan – although we recommend staying with your El Rio provider if you live in Pima County. By changing to AIHP there will be NO co-payments for medical services and medications."