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County Board member's Botox vote benefits family(Omaha World-Herald (NE) Via Acquire Media NewsEdge) Sep. 28--A Douglas County Board member now has health coverage for a relative's rare sweating condition after voting to add Botox treatment to the county's insurance plan. Pam Tusa was one of four County Board members last week to approve coverage for hyperhidrosis, or excessive sweating. Botox has emerged as the latest treatment for the condition that afflicts about 1 percent of the population. Tusa, who became eligible for the county's tax-supported health plan after taking office last year, did not publicly disclose that a family member would benefit from the policy change. She also said she didn't ask that Botox be added to the policy. County Administrator Kathleen Kelley introduced the idea to board members during a review of benefits earlier this year. Kelley heard from Tusa's husband after the county's insurance provider denied a claim for the treatment, but she said no one asked her to add Botox to the policy. At least two board members said they didn't think public disclosure by Tusa was legally required, particularly because it involved a medical matter. But board member Kyle Hutchings said that even if the vote were legal, "It certainly doesn't pass the smell test." A vote that benefits a board member is "wrong. It's just plain wrong," Hutchings said. The vote also added bariatric surgery for obesity and massage and acupuncture for skeletal and muscular problems. Together, the three insurance riders could increase the county's health care cost by as much as $1 million in 2009. Before the vote, the county and its employees were looking at a 14.2 percent increase in premiums, the first double-digit hike in several years. The additional coverage would push the increase to at least 15.7 percent. Board members on Tuesday, however, will consider tapping a medical reserve fund to ease the impact of the cost increase on employees. Board member Mike Boyle said the premium hike might wind up around 13 percent. Projected costs for Botox treatments for medical conditions are small compared with possible bariatric claims. Botox claims could range from $1,040 to as much as $83,208, depending on how many people use the benefit, according to a cost analysis. Bariatric claims, by comparison, could range from $208,019 to $624,058, the analysis said. Tusa, owner of a west Omaha coffee shop who won her first bid for office in 2006, said she never spoke to anyone in the county about hyperhidrosis. In an interview, she said her family's medical needs are private and that her vote should not change that. Tusa was one of two people who seconded the motion to approve changes in county health benefits. She said her vote was in favor of the whole package of additions. She declined to comment further on the vote. Under state law, elected officials face a possible a conflict of interest if their actions result in a financial benefit or detriment to themselves or their families. Frank Daley, executive director of the Nebraska Accountability and Disclosure Commission, said he could not comment on whether Tusa's vote on the insurance changes constituted a conflict. Tusa didn't file a disclosure form with his office, Daley said. Prior to the vote, Hutchings challenged the process the county used to decide which benefits to add to its health coverage. He said employees were not surveyed to determine their needs. The process is backward, he said. Board members Boyle, Clare Duda and Mary Ann Borgeson, all supporters of the change, said they agreed with Hutchings' concerns. But in the end, the three joined Tusa in approving the expanded coverage. The discussion before last week's vote never touched on hyperhidrosis. Board members focused on bariatric surgery and its potential to save the county money by helping employees reduce their weight and obesity-related health problems. Board members Chip Maxwell and Chris Rodgers joined Hutchings in voting no. Duda and Boyle said their votes had nothing to do with helping a fellow commissioner, although they were aware that it could benefit Tusa. Borgeson could not be reached for comment. In the past, Duda said, he opposed adding individual treatments to the county's health insurance. As the longest-serving commissioner, he said, he can't remember the board ever doing it. Duda said he feared that it would open a Pandora's box: If you're going to cover that condition, why not mine? But bariatric surgery seemed like a much-needed procedure that could benefit employees and taxpayers, he said. The hyperhidrosis, acupuncture and massage treatments were inexpensive enough to justify the help they might provide to employees, not just a County Board member, Duda said. Kathy Goodman, who handles health insurance matters in the county's human resources department, said she regularly hears from employees who would like expanded benefits to meet their family's health needs. Many have asked about bariatric surgery, which is why she suggested that board members consider making it part of the health plan. No employees have requested hyperhidrosis coverage, she said. Kelley has discussed at board meetings how she learned about the need for Botox for hyperhidrosis. "No hiding the ball on my part. No special consideration," she wrote in an e-mail Friday. Kelley said she got involved after learning that a family had received coverage for Botox, only to be told months later that a mistake was made. United Healthcare, the county's insurer, said Botox was an excluded treatment and that the family owed money paid on two earlier claims. Kelley wouldn't name the family, citing privacy rules. Tusa confirmed that her husband talked to Kelley after United Healthcare sent a denial notice. Her husband handles insurance matters for the family, Tusa said, so she wasn't aware of the conversation at the time. Her husband was referred to Kelley and never asked for special consideration or for a change in policy, she said. Kelley said she "never was requested to do anything other than to look into" United Healthcare's reversal on payment. She said the denial was unusual enough that she called an insurance executive for a different company in town to find out how other carriers handle payment mistakes. That executive told her insurance carriers usually pay for their own errors. United Healthcare agreed to honor the claim but said it would not pay future benefits for Botox. About that time, Kelley said, she heard a TV report on how Botox was more than a beauty tool and was increasingly used for medical conditions. The County Board was seeking input on its benefits. Kelley said she suggested Botox for hyperhidrosis because it "was the right thing to do." While the insurance claim alerted her to one family's need, she said, it wasn't the reason she took the matter to County Board members. Anyone who has the condition should be offered the benefit of a proven treatment, she said. It also wasn't an expensive benefit to offer, she said. Compared with many procedures that cost tens of thousands of dollars, "this is like a pimple. It's nothing. . . . I think it's a lot of to-do over nothing." --Contact the writer: 444-1116, [email protected] To see more of the Omaha World-Herald, or to subscribe to the newspaper, go to http://www.omaha.com. Copyright (c) 2008, Omaha World-Herald, Neb. Distributed by McClatchy-Tribune Information Services. 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