File #: 19-0929    Version: 1
Type: decision Status: Passed
File created: 10/8/2019 In control: LEOFF I Disability Board
Agenda date: 10/14/2019 Final action: 10/14/2019
Title: Approval of Case #08-19 Dental Request
Attachments: 1. Request

Title

Approval of Case #08-19 Dental Request

 

Report

Issue:

Whether to approve payment for dental work for a LEOFF 1 member.

 

Staff Contact:

Debbi Hufana, H R Analyst, Human Resources, 360.753.8149

 

Background:

The Board must decide whether or not to approve the request for dental work in the amount of $13,998.00.

 

The member originally contacted the City by email with a request for the City to assist in the cost to replace a bridge of 3 teeth that were crowns.  On the estimate, those are identified as teeth #11- #13.  The dentist is also recommending filling tooth #10 at the same time due to decay.  Total cost for this portion of the work is $4,846.00 which includes the cost to seat the new bridge.

 

The treatment plan provided by the dentist includes treatment on 12 additional teeth; however, the member’s application for payment is only asking for a new bridge to replace the one that fell out.

 

This request is in accordance with LEOFF 1 Disability Board Policies & Procedures.

 

Attachments:

Application for Payment of Services

Explanation of treatment plan

Treatment Plan

 

Reference:
H. Dental Benefits