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HomeMy WebLinkAbout09-05-2006 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5, 2006 - 10:00 a.m. - Council Conference Room MINUTES I. CALL TO ORDER Chair Jim Kelly called the meeting to order at 10:00 a.m. in the Council Conference Room located at Auburn City Hall, 25 West Main Street in Auburn. Chair Kelly and the following Board members were present: Chair Pro Tem Bud Larson (member-at-Iarge), Member Roger Thordarson, Member Rich Wagner, and Member Bill Petersen. Also present were LEOFF Fire retirees Ed Henderson and Alan Kosko, Board Attorney Joseph Beck and Board Secretary Danielle Daskam. II. APPROVAL OF MINUTES A. Minutes of the Julv 31. 2006 ReQular LEOFF Board MeetinQ Motion by Chair Pro Tem Larson, second by Member Thordarson to approve the July 31, 2006 minutes as distributed. MOTION CARRIED. 5-0. III. UNFINISHED BUSINESS A. PendinQ Disabilitv Leave/Retirement Applications There was no pending disability leave/retirement request. B. Medical/HearinQNision Claims 1 . Alan Kosko June 5, 2006 request from Alan Kosko for pre-approval of dental treatment in the amount of $475.00. On June 6, July 5 and July 31, 2006, the LEOFF Board tabled the above claim pending receipt of additional information supporting the medical necessity of the dental treatment requested. Mr. Kosko was in attendance and presented a letter dated May 30, 2006 from Daniel H. Ryning, DDS; a letter dated August 16, 2006 from Jason McGonegle, DDS; and a note dated August 23, 2006 from Mythili Arigala, MD regarding the need for his dental treatment. At this time, Chair Kelly inquired and Board Attorney Beck commented regarding the requirements of the Open Public Meetings Act and the discussion of potentially sensitive medical LEOFF Board Minutes September 5, 2006 Page 1 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5, 2006 - 10:00 a.m. - Council Conference Room LEOFF Board Minutes September 5, 2006 Page 2 information. Mr. Beck cautioned the Board regarding the exclusion of public from an open meeting. He suggested that the Board members discuss the claims in general. He also suggested that the Board could inquire of the LEOFF retirees and provide an opportunity for the retirees to object to discussion of potentially private medical information in open session or waive their privacy. Member Wagner noted that earlier today he submitted an e-mail with suggested language to clarify LEOFF Policy Section 8.02(0)(4) relating to dental benefits. He believes the LEOFF Board policy, as adopted earlier this year, has been widely misinterpreted as a much broader benefit than the Board intended. He suggested addressing clarification of the policy prior to acting on the pending claims. Board Attorney Beck recommended that the Board continue with consideration of the claims prior to amending the Board policies. Chair Kelly suggested considering the claims on the agenda prior to review and discussion of the proposed policy amendment. Motion by Member Petersen, second by Chair Pro Tem Larson to table Member Wagner's proposed policy amendment until later on the agenda. MOTION CARRIED UNANIMOUSLY. 5-0. Chair Kelly inquired of Mr. Kosko whether he had any objection to discussion of his claim in open session. Mr. Kosko waived any right to privacy as it relates to his current claim for reimbursement of dental expenses. Board members reviewed the documents submitted by Mr. Kosko today and Mr. Kosko's previously submitted claim documentation. Mr. Kosko spoke regarding his medical condition. He noted Dr. Arigala's statement that the dental work is medically necessary due to his underlying medical condition. Chair Kelly commented that none of the documentation received references a medical condition and how the dental treatment is medically necessary. Mr. Kosko stated that he believes he has responded to the Board's request by providing the statement from Dr. Arigala stating that the City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5,2006 -10:00 a.m. - Council Conference Room dental work is medically necessary due to Mr. Kosko's underlying medical condition. Chair Kelly stated that the information provided is too general and suggested that Mr. Kosko provide specific information regarding the cause and effect of the dental condition and treatment as it relates to his existing medical condition. Member Petersen indicated that he considers the note from Dr. Arigala similar to a prescription from a physician, whereby the Board would be obligated to pay. Member Wagner suggested tabling Mr. Kosko's claim pending receipt of more specific information regarding the cause and effect of the dental condition on the existing medical condition. Motion by Member Thordarson, second by Member Wagner to table Mr. Kosko's claim until the next Board meeting pending receipt of additional information regarding the cause and effect of the dental condition and treatment as it relates to the existing medical condition. MOTION CARRIED UNANIMOUSLY. 5-0. 2. Ed Henderson Request for reimbursement of June 28, 2006 dental treatments in the amount of $570.00. LEOFF Board Minutes September 5, 2006 Page 3 On July 31, 2006, the LEOFF Board tabled Mr. Henderson's claim pending the receipt of additional information to support the medical necessity of the dental treatment. Mr. Henderson submitted a letter dated August 30, 2006, a letter dated August 29, 2006 from Dr. Steven Smith DO, and letters previously submitted to the Board in 2002. Chair Kelly inquired of Mr. Henderson whether he had any objection to discussion of his claim in open session. Mr. Henderson waived any right to privacy as it relates to his current claim for reimbursement of dental expenses. Chair Kelly acknowledged receipt of an August 28, 2006 letter from Patrick Reagan, MD of Virginia Mason supporting the need for prompt treatment of any dental issues in order to minimize chances of subbacterial endocarditis. City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5, 2006 - 10:00 a.m. - Council Conference Room Board members also reviewed the letters submitted by Henderson and included in the agenda packet. Board members and Mr. Henderson briefly discussed his current medical condition. Member Petersen suggested that Mr. Henderson's statements from his doctors appear to sufficiently show the cause and effect of the dental treatment on Mr. Henderson's current medical condition. Motion by Member Petersen, second by Chair Pro Tem Larson to approve Mr. Henderson's claim in the amount of $570.00. MOTION CARRIED UNANIMOUSLY. 5-0. At this time, Chair Kelly requested that guests, Mr. Henderson and Mr. Kosko, leave the meeting room during discussion of the remaining claims due to medical privacy issues. Board Attorney Beck stated that the guests should be asked to leave the meeting during discussion of the medically significant facts, but the guests are entitled to be present during general discussion and action on the claims. Mr. Henderson and Mr. Kosko volunteered to leave the meeting room until the conclusion of the Board's actions on claims. 3. Richard Huseby Request for pre-approval of dental expenses for other dental treatment in the amount of $1507.50. LEOFF Board Minutes September 5, 2006 Page 4 On July 5 and 31, 2006, the LEOFF Board tabled Mr. Huseby's request pending the receipt of additional information supporting the medical necessity of the dental treatment. Mr. Huseby submitted a letter dated July 31, 2006 from Dr. Stuart Rich, DDS, in response to the Board's request. Board members reviewed the documents submitted by Mr. Huseby. Motion by Member Thordarson, second by Member Petersen to table Mr. Huseby's claim pending the receipt of more specific information from a physician showing the cause and effect of the dental treatment on Mr. Huseby's current medical condition. MOTION CARRIED UNANIMOUSLY. 5-0. City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5, 2006 - 10:00 a.m. - Council Conference Room 4. M. Eric Bearscove Request for reimbursement of dental treatments in the amount of $495.00. On July 5 and 31, 2006, the LEOFF Board tabled Mr. Bearscove's request pending the receipt of additional information supporting the medical necessity of the dental treatment. Mr. Bearscove submitted letters from Dr. Sean Wittmer, DMD, and himself received on August 9, 2006 in response to the Board's request. Board members reviewed the documents submitted by Mr. Bearscove. Motion by Member Thordarson, second by Member Petersen to table Mr. Bearscove's claim pending the receipt of more specific information from Mr. Bearscove's physician regarding the medical necessity for the treatment, including evidence of the cause and effect of the dental treatment on Mr. Bearscove's current medical condition. MOTION CARRIED UNANIMOUSLY. 5-0. 5. ROQer H. Lee Request for reimbursement in the amount of $3.23 per Medicare Explanation of Benefits Claim #11-06167-366-080 for medical services received on May 3, 2006. On July 31, 2006 the Board tabled the above claim pending receipt of the Regence Explanation of Benefits statement. Since that time, Mr. Lee has advised that according to the Regence Explanation of Benefits statement, the charges were paid in full; therefore, no further action by the Board is required. IV. NEW BUSINESS A. Disability Leave/Retirement Applications No new application for disability leave/retirement was filed. B. Appeals/Requests for Reconsideration 1 . Roqer Lee Request for reimbursement in the amount of $110.00 per Regence Explanation of Benefits Claim #0613995027101 for medical services received on April 26, 2006. LEOFF Board Minutes September 5,2006 Page 5 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5,2006 -10:00 a.m. - Council Conference Room On July 31, 2006 the Board denied the above claim finding that the medical services were preventative. On August 16, 2006, Mrs. Lee, on behalf of retiree Roger Lee, submitted the enclosed request for reconsideration and August 10, 2006 letter from Mr. Lee's physician, Dr. Pang. Dr. Pang's letter states that Mr. Lee is required to undergo regular physical exams annually due to medical issues that need attention. Motion by Member Thordarson, second by Member Petersen to table Mr. Lee's claim until the next meeting pending receipt of specific medical information regarding the reasons and issues for the medical treatment, including but not limited to the existing medical condition and the reason for the exam. MOTION CARRIED UNANIMOUSLY. 5-0. C. Medical/HearinQNision Claims 1. Ray OQden On May 2, 2006, the LEOFF Board pre-approved Mr. Ogden's request for reimbursement of in-home care or assisted living expenses. The benefit amount for daily in-home care and assisted living facility is $153.60 per day. Mr. Ogden moved to assisted living on July 1, 2006. Enclosed are Mr. Ogden's July and August 2006 statements as well as documentation regarding his personal service plan: a. Mr. Ogden's basic service rate - July 2006 (including adjustment recorded on Aug statement) Mr. Ogden's personal service fee - July (including adjustment recorded on Aug statement) $3,649.94 $ 349.79 b. Mr. Ogden's basic service rate - Aug 2006 Mr. Ogden's personal service fee - Aug $3,715.00 $ 349.79 (Note: 31 days X $153.60 = $4,761.60) Board members reviewed the documentation provided by Mr. Ogden. Motion by Member Petersen, second by Member Thordarson to approve the July 2006 expenses in the amount of $3,999.73. LEOFF Board Minutes September 5, 2006 Page 6 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5, 2006 - 10:00 a.m. - Council Conference Room MOTION CARRIED UNANIMOUSLY. 5-0. Motion by Member Thordarson, second by Chair Pro Tem Larson to approve the August 2006 expenses in the amount of $4,064.79. MOTION CARRIED UNANIMOUSLY. 5-0. 2. Ray Nixon Requests for reimbursement of dental expenses in the amount of $204 and $963 for dental services received on July 11, 13 and 14, and August 9, 2006. LEOFF Board Minutes September 5, 2006 Page 7 a. Request for reimbursement of dental x-ray and exam (July 11, 2006) in the amount of $76.00 and tooth extraction (August 9, 2006) in the amount of $128.00 for a total claim in the amount of $204.00. Motion by Member Petersen, second by Chair Pro Tem Larson to approve a portion of the claim in the amount of $76.00 for exam and x-ray and table the remaining claim pending receipt of medical information relating to the cause and effect. MOTION FAILED. 0-5. Motion by Chair Pro Tem Larson, second by Member Petersen to table the claim in the amount of $204.00 pending receipt of proof of medical necessity for the dental treatment involving the tooth extraction and confirmation whether Mr. Nixon had previously been reimbursed for a dental examination and x-rays. MOTION CARRIED UNANIMOUSLY. 5-0. b. Request for reimbursement of dental surgical expenses (July 14, 2006) in the amount of $963.00. Motion by Chair Pro Tem Larson, second by Member Petersen to table the claim in the amount of $963.00 pending receipt of proof of medical necessity for the dental/oral surgery including more specific information from Mr. Nixon's physician regarding the medical necessity for the treatment, including evidence of the cause and effect of the dental treatment on Mr. Nixon's current medical condition. MOTION CARRIED UNANIMOUSLY. 5-0. City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5,2006 -10:00 a.m. - Council Conference Room 3. John Baker Request for reimbursement of dental expenses in the amount of $2,000.00. Motion by Chair Pro Tem Larson, second by Member Thordarson to table Mr. Baker's claim pending further information on whether there had been prior reimbursement for dentures (partial or full) MOTION CARRIED UNANIMOUSLY. 5-0. 4. Edward Sluys Request for reimbursement of dental expenses incurred on July 25, 2006: Dental Examination Dental Cleaning $45.00 $80.00 Motion by Member Thordarson, second by Member Petersen to approve Mr. Sluys' claim in the total amount of $125.00. MOTION CARRIED UNANIMOUSLY. 5-0. 5. Robert S. Phillips Request for reimbursement in the amount of $167.30 per Regence Explanation of Benefits statement #0618195007800 for medical services received on June 23, 2006 and processed by the insurance on August 1, 2006. Motion by Member Petersen, second by Member Thordarson to approve Mr. Phillips' claim in the amount of $167.30. MOTION CARRIED UNANIMOUSLY. 5-0. Mr. Henderson and Mr. Kosko returned to the meeting at this time (11 :20 a.m.) D. Discussion 1. Proposed Clarification of Policy Section 8.02(0)(4) Board members reviewed an e-mail dated September 5,2006 from Member Wagner to Chair Kelly regarding LEOFF dental benefits. In the e-mail Member Wagner suggests the LEOFF Board amend its policies to better reflect the Board's intent when the current LEOFF Board Minutes September 5,2006 Page 8 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5,2006 -10:00 a.m. - Council Conference Room dental benefits were adopted earlier this year. Member Wagner believes that the current policy is widely misinterpreted as a much broader benefit than the Board intended. Member Wagner recommended adding the following clarifying language to Section 8.02(0)(4): The term "medically necessary" means that the expense is necessary in order to treat a current ongoing health problem. The medically necessary health problem must be diagnosed by a doctor qualified to treat such problems. The definition of "medically necessary" does not include reimbursement for expenses that are primarily for improved dental function, including but not limited to, fillings, root canals, crowns, and implants, even though these treatments may provide improved resistance to infections and/or better chewing of food. Expenses for replacement or installation of crowns, fillings, implants, bridges, dentures, etc. due to normal wear or breakage will not be reimbursed unless the replacement or installation is necessary due to an accidental injury that is not caused by normal biting or chewing. Board members discussed the current policy and the proposed amendment. Board members agreed that Member Wagner would prepare a draft letter addressed to LEOFF members to better articulate the Board's intent with regard to dental benefits. Member Wagner will forward the draft letter to the Board Secretary for distribution to the remaining Board members. The draft letter will be presented to the Board at their next meeting for action. 2. Ed Henderson Mr. Henderson briefly addressed the Board regarding procedure and submission of claims and issues related to prior Board approvals. LEOFF Board Minutes September 5, 2006 Page 9 City of Auburn Law Enforcement Officers and Firefighters Disability Board Tuesday September 5,2006 -10:00 a.m. - Council Conference Room v. ADJOURNMENT There being no further business to come before the Board, the meeting adjourned at 11 :56 a.m] APPROVED THE ~'f/' DAY OF OCTOBER, 2006. '"' . lie Daskam, Secretary LEOFF Board Minutes September 5, 2006 Page 10