2024-02-06 Disability Board PacketEDMONDS LEOFF 1 DISABILITY
MEETING NOTICE AND AGENDA
REGULAR MEETING
Tuesday, February 6, 2024
Fourtner Room City Hall
11:00 am
• CALL TO ORDER
• APPROVAL OF MEETING MINUTES
a. From the 11/20/2023 meeting
• DISCUSS AND APPROVE CLAIMS SUMMARY REPORT
b. For the period 10/01/2023 — 12/31/2023
• BUSINESS
c. Review/Discuss member request for ambulance reimbursement.
• OTHER
o Next Board Meeting date (April 2024)
Page 1
EDMONDS' DISABILITY BOARD
Meeting Minutes
Regular Meeting
11 /20/2023
MEMBERS PRESENT:
Ken Jones, Board Chair
Gary McComas, Board Member
Susan Paine, Council President
Jim Distelhorst, Citizen -at -Large
MEMBERS ABSENT:
Jenna Nand, Council Member
STAFF PRESENT:
Carly Derrick, HR Analyst
Jessica Vuong, HR Assistant
RaeAnn Duarte, HR Manager
MEMBERS OF THE PUBLIC PRESENT:
None
CALL TO ORDER:
Board Chair Jones called the meeting to order at 11:10 AM.
APPROVAL OF MINUTES:
Meeting minutes for May 5, 2023, motioned by Council Member Paine and seconded by Board member
Distelhorst. Minutes approved unanimously.
Meeting minutes for October 10, 2023, motioned by Council Member Paine and seconded by Board
Member McComas. Minutes approved unanimously.
DISCUSS AND APPROVE CLAIMS SUMMARY REPORT 07/01/2023 to 09/30/2023
Summary of Current
Costs
07/01 /2023 - 09/30/2023
SERVICE
Number of Claims
Total Paid for Service
Dental Expenses
2
$ 519.66
Hearing Aid
1
$ 60.00
Long Term Care
13
$ 71,968.44
Medical Services
5
$ 477.72
Prescription
7
$ 793.28
Grand Total
28
$ 73,819.10
Edmonds Disability Board — 11/20/2023
Council member Paine made a motion to approve the claims summary report. Board member
McComas seconded. Motion carried unanimously.
BUSINESS
Review 005-06 Medicare Premium Reimbursement
Board reviewed policy. Council Member Paine made a motion to approve the policy as written with no
changes. Board member Distelhorst seconded. Motion carried unanimously.
Other
4th quarter meeting scheduled for January 19th at 11:00 a.m. in person.
Chair Jones adjourned the meeting at 11:20 a.m.
1'
Page 2 of 2
CITY OF EDMONDS DISABILITY BOARD
CLAIMS SUMMARY
CLAIM NO.
SERVICE
RCW/PAST PRACTICE
COST
44
Long Term Care
008-11
$ 3,292.89
Prescription
010-15
$ 38.70
45
Long Term Care
008-11
$ 7,000.00
46
Prescription
010-15
$ 33.78
Long Term Care
008-11
$ 3,292.89
47
Prescription
010-15
$ 162.70
Medical Services
RCW
$ 75.00
Dental Expenses
002-05
$ 78.00
48
Prescription
010-15
$ 273.16
Medical Services
RCW
$ 98.00
Dental Expenses
002-05
$ 149.00
49
Prescription
010-15
$ 283.80
Total Approved Claims Total Reimbursed $ 14,777.92
Disability Board 2023 Q4 City of Edmonds - Human Resources Department Page 1
Current and Historial Claim Count & Costs
Summary of Current
Costs
10/01 /2023 - 12/31 /2023
SERVICE
Number of Claims
Total Paid for Service
Dental Expenses
2
$ 227.00
Long Term Care
3
$ 13,585.78
Medical Services
2
$ 173.00
Prescription
5
$ 792.14
Grand Total
12
$ 14,777.92
Summary of Historical
Costs
10/01 /2022 - 12/31 /2022
SERVICE
Number of Claims
Total Paid for Service
Dental Expenses
1
$ 700.00
Long Term Care
6
$ 27,878.67
Medical Services
2
$ 237.15
Prescription
6
$ 1,167.49
Grand Total
15
$ 29,983.31
Disability Board 2023 Q4 [02/06/2024] City of Edmonds - Human Resources Department Page 2
CURRENT SUMMARY OF
COST BY BARS NUMBER 10/01/2023 - 12/31/2023
LEOFF 1 Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
009.000.39.517.20.23.00
$64,000.00
$33,874.29
$30,125.71
52.93%
Reimbursement Benefits
009.000.39.517.20.23.10
$142,650.00
$90,134.92
$52,515.08
63.19%
Premium Benefits
009.000.39.517.20.29.00
$152,990.00
$150,101.84
$2,888.16
98.11%
In Home/Assisted Living
009.000.39.517.20.41 - 49
$7,500.00
$19,000.00
($11,500.00)
253.33%
Proff. Svcs, Travel, Misc.
Expenses
TOTAL:
$367,140.00
$293,111.05
$74,028.95
79.84%
Fireman's Pension Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
001.000.39.517.20.23.20
$10,000.00
$2,850.00
$7,150.00
28.50%
Reimbursement Benefits
001.000.39.517.20.23.10
$14,560.00
$12,024.74
$2,535.26
82.59%
Premium Benefits
001.000.39.517.20.23.00
$25,000.00
$4,385.22
$22,076.52
11.69%
Pension & Other Benefits
001.000.39.517.20.29.00
$165,023.00
$70,052.43
$94,970.57
42.45%
Pension and Disability
Payments
001.000.39.517.20.41.00
$1,200.00
$12,500.00
($11,300.00)
1041.67%
Professional Svcs.
TOTAL:
$215,783.00
$101,812.39
$115,432.35 47.18%
Disability Board 2023 Q4 [02/06/2024] City of Edmonds - Human Resources Department Page 3
HISTORICAL SUMMARY
OF COST BY BARS
NUMBER 10/01/2022 - 12/31/2022
LEOFF 1 Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
009.000.39.517.20.23.00
$64,000.00
$48,210.96
$15,789.04
75.33%
Reimbursement Benefits
009.000.39.517.20.23.10
$142,650.00
$103,363.32
$39,286.68
72.46%
Premium Benefits
009.000.39.517.20.29.00
$252,990.00
$97,590.63
$155,399.37
38.57%
In Home/Assisted Living
009.000.39.517.20.41 - 49
$7,500.00
$13,704.25
($6,204.25)
182.72%
Proff. Svcs, Travel, Misc.
Expenses
TOTAL:
$467,140.00
$262,869.16
$204,270.84
56.27%
Fireman's Pension Fund
BARS NUMBER
ANNUAL APPROPRIATION
YTD EXPENDITURE
BALANCE
% USED
001.39.517.20.23.20.23.20
$10,000.00
$4,530.84
$5,469.16
45.31 %
Reimbursement Benefits
001.000.39.517.20.23.10
$14,560.00
$15,116.76
-$556.76
103.82%
Premium Benefits
001.000.39.517.20.23.00
$25,000.00
$5,515.20
$19,484.80
22.06%
Pension & Other Benefits
001.000.39.517.20.29.00
$70,944.00
$86,136.64
-$15,192.64
121.41 %
Pension and Disability
Payments
001.000.39.517.20.41.00
$1,200.00
$0.00
$1,200.00
0.00%
Professional Svcs.
TOTAL:
$121,704.00
$111,299.44
$10,404.56 91.45%
Disability Board 2023 Q4 [02/06/2024] City of Edmonds - Human Resources Department Page 4
G
Hi Carly,
I am still picking up the pieces from my severe illness during the past year.
One of the medical expenses was a $1714.55 bill from Northwest
Ambulance which covered an ambulance ride from Providence Colby
Hospital to the first convalescence facility which I went to, Prestige
Rehabilitation. I was never asked how I preferred to travel and, as a matter
of fact, I was only semi -conscious and barely remember the trip. I always
assumed that Medicare would pick up the charges and it took several
months for the bill to catch up with me since Northwest's business office
apparently thought that I was a permanent resident at Prestige. By the time I
got home in May, I finally got a call from Northwest, who had had the bill
rejected by Medicare, which I appealed. They then turned the bill over to a
collection agency and, in order to end the calls from them, I paid them
$1739.92, which included some bad debt charges. Since I consider it to be a
necessary medical expense, I am asking for reimbursement of the original
$1714.55. I have enclosed my letter of appeal to Medicare, which was
turned down, for the second time.
Thanks!
APPEAL OF CLAIM # 11-23012-257-920
On October 28, 20221, was taken to the Emergency Dept. of
Providence Hospital Colby Campus in Everett, WA suffering from extreme
intestinal pain and discomfort. He was admitted to the hospital after
numerous tests and received a diagnosis of kidney stones which progressed
to sepsis. His condition worsened over several weeks and he was discharged
from the hospital on November 21, 2022 and sent to a skilled nursing
facility in Edmonds, WA with orders for continued antibiotic therapy via
intravenous delivery. His condition at the point of discharge was frail and he
couldn't walk or stand. Transportation via ambulance with qualified medical
personnel was a medical necessity and the only choice due to his condition
which was poor and not improving. Ambulance service was also necessary
since medical intervention may have been necessary during the trip between
the hospital and the skilled nursing facility. tay in the skilled
nursing facility was lengthy and he was not released from medical care for
five months. This transportation by ambulance was a medical necessity.
BILL I Page 22 of 42
s November 2L 2022
_L Platinum Nine Holdings LLC, (877)480-2929
PO Box 3510, Silverdale, WA 98383-3510
Amount
Medicare-
Amount
See
Service
Provider
Approved
Medicare
You May Notes
Service Provided & Billing Code Approved?
Charged
Amount
Paid
Be Billed Below
...............
.............................................................................................................................................................................
Ambulance service, basic life NO
$1,296.75
$0.00
$0.00
$1,296.75 H
support, non -emergency transport,
(bls) (A0428-HNGY)
...................................................................................................................................................................................................................
Ground mileage, per statute mile NO
417.80
0.00
0.00
417.80 H
(A0425-HNGY)
...............................
.......................................................................................................................................................................................
Total for Claim # 11-23012-257-920
$1,714.55
$0.00
$0.00
$1,714.55 I
November 21, 2022
Providence Health & Services, (425)347-6330
PO Box 3360, Portland, OR 97208-3360
ount Medicare- Amount See
Service Provider Approved Medic Notes
Service Provided & Billing Code Approv Charged Amount aid Below
......................................................................................................................................................... ................ ...............
Dr. Fenton Portillo, F., M.D.
................................................................................................................................................................................................ ...............
Hospital discharge day Yes $277.00 $10 .63 $83.43 $20.93 J,K
management, more than 30
minutes (99239) ..............
..................................................... .... .... .
Total for Claim # 11-223-402-450 SZ, .00 $104.63 $83.43 $20.93 I
Notes for Claims Above
H Medicare does not pay for this item or service.
This information is being sent to your private insurer(s). Send any questions regarding your benefits to
them. Your private insurer(s) is/are WEBTPA EMPLOYER SERVICES.
J After your deductible and coinsurance were applied, the amount Medicare paid was reduced due to
Federal, State and local rules.
K This claim shows a quality reporting program adjustment.
x
THIS IS NOT A BILL I Page 3 of 9
Your Claims for Part B (Medical Insurance)
Part B Medical Insurance helps pay for doctors'
services, diagnostic tests, ambulance services, and
other health care services.
Definitions of Columns
Service Approved?: This column tells you if
Medicare covered the service.
Amount Provider Charged: This is your provider's
fee for this service.
Medicare -Approved Amount: This is the amount a
provider can be paid for a Medicare service. It may be
less than the actual amount the provider charged.
November 21, 2022
Platinum Nine. Holdings LLC, (877)480-2929
PO Box 3510, Silverdale, WA 98383-3510
-7-,i
Your provider has agreed to accept this amount'Y
as full payment for covered services. Medicare
usually pays 80% of the Medicare -approved amount.
Amount Medicare Paid: This is the amount
Medicare paid your provider. This is usually
8096 of the Medicare -approved amount.
Maximum You May Be Billed: This is the total
amount the provider is allowed to bill you and can
include a deductible, coinsurance, and other charges
not covered. If you have Medicare Supplement
Insurance (Medicap policy) or other insurance, it
may pay all or part of this amount.
Amount
Medicare-
Amount
Service Provided &Billing Code
Service
Approved?
Provider
Charged
Approved
Amount
Medicare
Paid
Ambulance service, basic life
NO-
$1,296.75
$0.00
$0.00
support, non -emergency transport,
adjusted
(bls) (A0428-HN)
...........,........................
.......................
Wile"
(A0425, HN)
...........-......................
41..7.8.0 ................0.00.....0.00
........
..... ...Gr.o..u.n.d..m.i.g
.. ...or. .... .............................................
adjusted....
........... ................................
Total fClaim # 46-23157-014-010
....... .................................
$1,714.55
.........
$0.00
.
$0.00
lotes for Claims Above
' See
You May Notes
BilledBe Below
...............
31,296.75 A
..... ........... ........
1 714..551.B ...........
The information provided does not support the need for this service or item.
If you disagree with the Medicare -approved amount, you may ask for a reconsideration within 180 days
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