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Patient Benefit Coordinators

Patient Benefit Coordinators (PBCs) are responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. PBCs identify patients who are eligible for alternative resources and serve as liaisons between the patient, hospital, and governmental agencies.

PBCs also provide leadership and act as advocates for American Indian patients in the effective utilization of alternate resources such as Medicare, Medicaid, Department of Veterans Affairs (DVA), Third Party Liability, Sooner Care, Advantage Waiver, and other resources.

PBC’s are available Monday through Friday from 8:00 am until 5:00 pm.

Sooner Care

At no cost to you, SoonerCare provides our children and families additional options if they need medical attention outside of Cherokee Nation. Billing SoonerCare at Cherokee Nation health centers also brings in more funding for new medical equipment and services.

Visit a Patient Benefit Coordinator at any Cherokee Nation health center or call our tribe’s SoonerCare hotline at 844-749-4263.

Medicare

Medicare is health insurance for people age 65 and older. Individuals are eligible to sign up for Medicare 3 months before turning 65. Some may be eligible for Medicare earlier if they have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).

Department of Veterans Affairs (DVA)

The Veterans Health Administration provides primary care, specialized care, and related medical and social support services to American veterans. By law, the U.S. Department of Veterans Affairs (VA) is required to bill private health insurance providers for medical care, supplies, and prescriptions provided for treatment of veteran’s conditions not connected to their service.

Third Party Liability

Third Party Liability (TPL) is the legal obligation of a third party to pay part or all of the services furnished under a health plan. In some instances, these services are related to an accident or injury that is covered under a different insurer’s plan—such as auto or workers’ compensation insurance. This is called a "third party payer."

Advantage Waiver Program

The Advantage waiver program is for adults with physical disabilities age 21 and older. This program does not include waivers for those with intellectual disabilities or cognitive impairments.

Marketplace (ACA):

The Health Insurance Marketplace, considered a health insurance exchange, allows consumers in the United States to purchase private individual and family insurance plans. Individuals can also receive income-based subsidies for affordable healthcare insurance coverage. Under the Affordable Care Act (ACA) are special provisions for American Indians, which offer low cost to no cost coverage.