Title
Case #16-18 Dental Request
Report
Issue:
Whether or not to approve payment for a crown and bridge for LEOFF member and for what amount.
Staff Contact:
Debbi Hufana, General Government, Human Resources, 360.753.8149
Background:
The member is requesting preapproval from the board for dental work in the amount of $5,475.00. The member has a gap and broken tooth to be restored with a bridge and a crown and a broken existing crown. The bridge is recommended to fill the gap and the crowns are recommended to fix the broken tooth and replace the existing cracked crown. This treatment is recommended to save the existing teeth. The cost of the procedure exceeds the allowable amount of $600/year for regular dental care. This is in accordance with LEOFF l policies and procedures. The LEOFF member has not completed this procedure yet.
Attachments:
Application for payment of services and proposed treatment plan
Reference:
LEOFF Disability Board Policies and Procedures (2018) Section H, Dental Benefits