General Eligibility Information
American Indians enrolled with U.S. federally recognized tribes and children or grandchildren of Fond du Lac enrollees are eligible to receive a variety of health and social services from the Fond du Lac Human Services Division programs and staff.
All Indian people living within the Fond du Lac Reservation service area of Carlton and southern St. Louis Counties are eligible to receive services provided by the Chemical Dependency, Public Health Nursing, and Social Services programs. Some health and social services programs may have additional eligibility requirements. These requirements vary with the program or service and are available upon request.
Clients must provide proof of tribal enrollment when registering for medical and dental services. In order to determine what services are available to the client, the Client Registration Clerk will interview the client to determine eligibility for:
- Direct Care (medical, dental, pharmacy, lab and x-ray)
- Contract Health Services (services contracted out to other healthcare providers).
Non-Indian Fond du Lac Reservation employees and non-Indian family members covered by FDL Insurance may receive limited services from the Fond du Lac medical clinic and pharmacy.
Direct Care services refer to those health and social services available directly from the Fond du Lac Human Services staff and provided in one of the Human Services facilities, such as the Min No Aya Win Human Services Center or the Center for American Indian Resources.
There is no charge to the client for Direct Care, but Medical Assistance and other third party payers (like insurance companies) are billed whenever possible.
Some services are available free of charge only to Fond du Lac enrollees and their descendents, as these services are totally funded by the Fond du Lac Reservation Business Committee. Examples of these services include Optometry and the Foot Orthotics Program.
Contract Health Services (CHS)
Contract Health Services are those medical and specialized health services that cannot be directly provided by the Fond du Lac medical clinics. Contract Health Services are purchased for eligible persons with funds provided by the Indian Health Service. By Federal regulation, these funds may be used only after it has been established that no other resources (such as private insurance or Medical Assistance) are available to the person requiring contracted health care. In order to be eligible for Contract Health Services a client must be a(n):
- Fond du Lac enrollee and live in the service area, or
- Child or grandchild of a Fond du Lac enrollee and live in the service area, or
- Enrolled member of a federally recognized tribe and live within the Fond du Lac Reservation boundaries.
In order to make the most efficient and effective use of the limited amount of Contract Health Service dollars provided to Fond du Lac, certain requirements for contract health care must be met. These requirements include:
- A Fond du Lac primary care provider must refer the client to another health care provider, specialist or hospital in order to have their care paid for with Contract Health Services funds.
- When the FDL clinics are closed, CHS eligible clients may report directly to an emergency room or physician to receive care.
- The client (or responsible party) must inform the Contract Health Services Clerk (879-1227) within 72 hours that they have received health care outside of the Fond du Lac medical clinic.
- "Emergency" means any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of the individual.
- In emergency cases, the client (or responsible party) must inform the emergency room or physician that Fond du Lac Contract Health Service is to be billed for the service.
- Follow-up care for the emergency must be received at the Min No Aya Win Human Services Center or the Center for American Indian Resources, or be approved by the CHS Clerk to be received elsewhere.
The services covered by Contract Health Service funds vary from time to time, as determined by the Reservation Business Committee. Some services which are not currently covered by Contract Health include (but are not limited to):
- Cosmetic surgery
- Physical therapy
- Chiropractic treatments
- Massage therapy
- Chemical Dependency assessments
- Mental Health services
Important Facts to Remember about Contract Health Services:
Federal Law requires that all public and private medical insurance be billed before Contract Health can pay for health-related care and services.
Since Minnesota law requires that individuals have automobile insurance, Contract Health will not pay for injuries related to auto accidents.
Contract Health can not cover job-related injuries, as all employers are required to provide worker's compensation insurance.
Not all visits may be covered by Contract Health Service; in such cases the client is responsible for the payment.
Client Registration, Fees and Billing
It is very important that clients bring their insurance cards when they come for an appointment. Fees are based upon the services provided to the client. A copy of our fee schedule is available upon request. By Federal law, the Fond du Lac Human Services must bill private insurance, Medical Assistance or other resources that clients may have for services received.
All medical, x-ray, laboratory, pharmacy, optometry and dental services are billed to a client's public or private insurance company for payment. Indian clients are not billed for co-pays or deductibles. Non-Indian clients with FDL Insurance may use the Fond du Lac health services but will be billed for co-pays and deductibles not covered by their insurance plan.