Pascua Yaqui Tribe

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Maricopa Managed Care

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Southwestern Eye 6101 S. Rural Rd
Tempe, AZ 85283
Weekdays: 8:00 am to 5:00 pm
Phone: (480) 517-0047

NOTICE FROM THE MARICOPA YOEME MANAGED CARE PROGRAM
TRIBAL MEMBERS LIVING IN MARICOPA COUNTY

  • P.I.M.C. is the health care facility for Yaqui Tribal members. Specialty referrals must have a Prior Authorization from MYMCP.
  • Tribal Members must register at Phoenix Indian Medical Center (P.I.M.C.) for all services.
  • Tribal Members are required to notify the MYMCP within 72 hours if using any other emergency services. Please call one of the following numbers for notification: (520) 879-6041 or (888) 443-0044.
  • The prior authorized referrals and claims will be processed by the Managed Care Program.
  • All Services will require Medical Review and authorization for payment. The program does not pay for routine outpatient medical services.
  • The Maricopa Yoeme Managed Care Program is a payor of last resort and will no longer pay any co-pays, deductibles or co-insurance for members with private insurance.
  • All Tribal members are required to determine annually whether they are eligible for AHCCCS health coverage, and again any time you are admitted to a hospital. If you are eligible for an alternative resource (AHCCCS, Medicare etc.) but fail to apply and complete the application process, you may be responsible for services you have received. If members choose to refuse to apply for AHCCCS or comply with AHCCCS requirements, this will be considered an automatic denial.

 

The Managed Care Program Patient Advocate is located at the Itom Hiapsi Guadalupe Office Complex. The Patient Advocate will assist members to apply for AHCCCS, as well as to collect medical bills or information regarding claims. Should you have any further questions or need assistance with understanding the Maricopa Yoeme Managed Care Program, please contact the Yoeme Managed Care Program Patient Advocate at (480) 768-2092. Hours are Monday – Friday 8:00 am to 5:00 pm.

 

Optical Information


WHO IS COVERED FOR OPTICAL?

Eligible Pascua Yaqui Tribal Members, residing within Maricopa County; must have a current and completed Alternate Resource application (AHCCCS). Since funding is limited, members are required to utilize Alternate Resources such as Vision Service Program (VSP), private vision insurance and AHCCCS primarily. Co-pays will be the responsibility of the member when an alternate resource is available. If you choose to go to a provider of your choice, you will be responsible for the cost of those services.

WHERE CAN I CALL TO MAKE AN APPOINTMENT?

Southwestern Eye
6101 S. Rural Rd
Tempe, AZ 85283
(480) 517-0047

The above provider will contact the Yoeme Managed Care Program to request prior-authorization.

HOW OFTEN CAN I RECEIVE OPTICAL SERVICES?

Optical services that include eye exams, glasses, or contacts will only be authorized every 2 years.

HOW MUCH WILL IT COST?

The Yoeme Managed Care Program only covers the eye exam and select frames and lenses or contacts at the contract rate. Any additional costs will be your responsibility.

Please Note: If you require an upgrade due to a medical necessity; the provider will submit a request for Medical Review.

NON-COVERED ITEMS:

Tinting, Progressive Lenses, Loss of Eyewear (contacts/glasses), Scratch Resistant, Featherweight Lenses, and other upgrades that are not medically necessary.