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