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Category 2: Sensitive information <br />Category 2: For official use only / disclosure permissible by law. <br />August 15, 2024 <br /> <br /> <br />City of Everett <br />LEOFF 1 Police Pension Board <br />To Whom it may concern: <br />I am requesting pre-approval for restorative work (Implant) to replace a tooth that was extracted <br />this year due to decay and resorption. <br />My Dentist, Dr. Mark Stockwell, while prepping for a filling, noted that internal resorption may be <br />occurring. I was referred to Dr. Ashley Barrineau, Alderwood Endodontics, to determine if my tooth <br />was salvageable. Dr. Barrineau determined that resorption was present and sent her findings back <br />to Dr. Stockwell. Dr. Stockwell recommended to me that the tooth be extracted with implant <br />placement. I was referred to OM3 in Everett where my tooth was extracted and a bone graft <br />completed by Dr. Peter Kim on 06/04/2024. I am currently scheduled for an implant consultation on <br />September 11th at OM3. Additional appointments will follow for Implant placement, testing for <br />stability, and eventually being referred to Dr. Stockwell for final restoration. <br />I am enclosing Dr Stockwell’s referrals to Alderwood Endodontics and OM3, as well as their reports <br />back to Dr Stockwell documenting examinations and work completed. In addition, I am enclosing <br />for pre-approval from Dr. Peter Kim outlining the potential costs of the implant $6985.00. <br />Currently, I have used $2230.00 of the $2500.00 available to me for this year. Our plan allows for “All <br />members who exceed or need additional work can submit up to $4000.00 for board approval.” I am <br />requesting that the additional amount be pre-approved. <br />Should the additional amount be approved, I request clarification. Does OM3 submit the bills to <br />HMA so the discounts apply, or to I prepay and request reimbursement? <br />Thank you for your consideration, <br />