Title
Approval of Case #20-4 Medical Request
Report
Issue:
Whether to approve payment for medical expenses not covered by MedAdvantage.
Staff Contact:
Debbi Hufana, HR Analyst, Human Resources, 360.753.8149
Background:
The Board must decide whether or not to approve payment for medical testing not covered by the members MedAdvantage medical plan.
The LEOFF 1 member, submitted documentation from Kaiser Permanente denying payment due to medical necessity not met. The LEOFF 1 member also submitted documentation from Providence Medical Group Neurosurgery Clinic stating this test is the only reliable method of diagnosis to possibly avoid brain surgery in the future.
Attachments:
Application for Payment of Services
Providence Medical Group Neurosurgery Clinic letter of medical necessity
Kaiser Permanente claim denial
South Sound Radiology Receipt for payment of services
Reference:
Section III Procedures to Receive Benefits, A. Medical Services