12-000535 Megan Hotchkiss vs. Department Of Management Services, Division Of State Group Insurance Status: Closed Recommended Order on Thursday, August 23, 2012.

Summary: Petitioner is entitled to payment for the second side of a bilateral procedure, but otherwise failed to prove that payment for services was not consistent with the terms of the State Employees' PPO Plan.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

MEGHAN HOTCHKISS , )

)

Petitioner, )

)

vs. ) Case No. 12 - 053 5

)

DEPARTMENT OF MANAGEMENT )

SERVICES, DIVISION OF STATE )

GROUP INSURANCE, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was held in this case

on April 9, 2012, by video teleconference at sites in

Tallahassee, Florida and Jacksonville, Florida, before E. Gary

Early, a designated Administrative Law Judge of the Di vision of

Administrative Hearings.

APPEARANCES

For Petitioner: Brian J. Lee, Esquire

644 Cesery Boulevard, Suite 250

Jacksonville , F lorida 32211

For Respondent: Sonja P. Mathews, Esquire

Department of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399 - 0950

STATEMENT OF THE ISSUE

The issue is whether Respondent properly denied payment of

certain charges related to out - of - network surgical procedures

pursuant to the State Employees Ó PPO Group Health Insurance

Plan .

PRELIMINARY STATEMENT

By letter dated June 16, 2010, Respondent , Department of

Management Services, Division of State Group Insurance

(Respondent or DSGI ) , notified Pet itioner , Meghan Hotchkiss

(Petitioner) , that it intended to deny her Level II Appeal, by

which Petitioner challenged the decision of Blue Cross & Blue

Shield of Florida ( BCBSF ) , to pay $1,526. 5 7 of a total of

$29,976.00 in surgery - related charges from Dr. Mark Piper, a

non - network provider. Petitioner received the notice on July 2,

2010.

On July 23, 2010 , Petitioner filed a Petition to Request a

Hearing ( Formal Hearing ) . Petitioner alleged that ÐBCBSF

inappropriately classified the surgery that I underw ent, in

violation of its plan documents, as some other kind of procedure

than the one I had, which had a much lower allowance.Ñ

On February 9, 2012 , Respondent referred the P etition to

the Division of Administrative Hearings. The record is silent

as to the reason for the passage of more than 1 1/2 years from

the date of filing of the Petition to the date of transmittal,

but there has been no objection by Petitioner.

The final hearing was scheduled for April 9 , 2012 , and was

held as scheduled. At the final hearing, Petitioner testified

on h er own behalf. PetitionerÓs Exhibits 1(a) - (c) and 4 - 6 were

received into evidence. Respondent presented the testimony of

Kathy Flippo, a registered nurse and RespondentÓs Legal Nurse

Specialist; Kevin Tincher, BCB SF Ós Senior Manager of Coding and

Professional Payment; Colleen McArdle, BCBSF Ós Manager of Pre -

service Medical Review; and Jessica Bonin, BCBSF Ós Critical

Inquiry Analyst. RespondentÓs Exhibits 2, 6, and 7 were

received into evidence.

By agreement of th e parties, the record was held open to

allow for the filing of deposition testimony to be considered in

lieu of live testimony. On August 7, 2012, prior to the closing

of the record, t he parties each filed the deposition transcript

of Dr. Scott Imray, a c onsulting expert witness retained by

Respondent . Since both parties filed the deposition transcript

prior to the closing of the record , indicating their mutual --

though independently expressed -- desire to have it be

considered by the undersigned, the de position transcript and its

exhibits are accepted and admitted in evidence as Joint

Exhibit 1.

Dr. Imray was proffered by Respondent as an expert in the

area of oral and maxillofacial surgery. Counsel for Petitioner

had no questions regarding Dr. Imra yÓs qualifications, and no

objection to the proffer has been made. Based on Dr. ImrayÓs

qualifications as set forth in his curriculum vitae and his

testimony, he is accepted as proffered. The deposition

transcript will be considered as though the witness testified in

person.

The final hearing was not transcribed. The date for filing

post - hearing submittals was set for August 17, 2012. Respondent

timely filed its Proposed Recommended Order , which ha s been

considered in the preparation of this Re commended Order. In its

Proposed Recommended Order, Respondent included three

appendices . Appendix A consisted of a document that w as not

entered in evidence at the final hearing or by agreement of the

parties prior to the closing of the record. Appendi ces B and C

consist of duplicates of documents introduced as parts of

PetitionerÓs Exhibits 1(a) and 1(c) , respectively. Those

documents are not admitted as evidence, and are not part of the

evidentiary record of this proceeding. Petitioner filed her

Pro posed Recommended Order on August 21, 2012. Although filed

late, the undersigned finds no prejudice would result from

consideration of PetitionerÓs Proposed Recommen ded Order, and it

has therefore been considered in the preparation of this

Recommended Ord er.

FINDINGS OF FACT

1. At all times pertinent to this proceeding, Petitioner ,

who is now 29 years old , was an employee of the University of

West Florida, and was enrolled as a member of the State

Employees PPO Plan (Plan) . S he started employment with t he

University on December 1, 2007 , and became enrolled in the Plan .

Respondent was provided with the State EmployeesÓ PPO Plan Group

Health Insurance Plan Booklet and Benefits Document, e ffective

January 1, 2007 (Plan Booklet) .

2. The Department of Ma nagement Services is responsible

for all aspects of the purchase of health care for state

employees , including those services provided under the Plan .

Respondent is responsible for the administration of the state

group insurance program.

3 . As authori zed by law, Respondent has contracted with

Blue Cross & Blue Shield of Florida (now known as Florida Blue)

as its third - party medical claim administrator of employee

health insurance benefits.

4 . The Plan Booklet contains the terms and conditions of

the state group insurance program applicable to this proceeding.

The booklet provides, as part of its Summary of Benefits, that:

When you go to non - network providers, this

Plan pays benefits based on the non - network

allowance. If your provider charges more

than the non - network allowance, you are

responsible for any amounts above the non -

network allowance. In addition, because the

Plan pays a lower benefit level for non -

network care, you pay more out - of - pocket for

non - network care.

In selecting BCBSF as the Medical Claim

Administrator for the state EmployeesÓ PPO

Plan, DSGI agreed to accept the non - network

allowance schedule used by BCBSF to make

payment for specific healthcare services

submitted by non - network providers.

Keep in mind that you will receive benefits

at the non - network level whenever you use

non - network providers, even if a network

provider is unavailable . (Emphasis added ) .

5 . The booklet provides, in s ection 6, entitled About the

Provider Network, that:

In an effort to contain healthcare c osts and

keep premiums down, BCBSF has negotiated

with PPC SM network healthcare providers to

provide services to health Plan participants

at reduced amounts. PPC SM network providers

have agreed to accept as payment a set

amount for covered services . . . .

Non - network providers will bill you their

regular charges. You will be responsible

for a larger coinsurance and/or copayment,

and you will be responsible for paying the

difference between the providerÓs charges

and the amount established as the non -

net work allowance for the service. The non -

network allowance may be considerably less

than the amount the non - network provider

charges.

* * *

An Important Note About Using Non - Network

Providers

To make sure you receive the highest level

of benefits from t he Plan, itÓs important to

understand when non - network benefits are

paid. When you use non - network providers,

you receive non - network benefits. Here are

some examples.

1. In some situations, your network

provider may use, or recommend that you

receive care from, a non - network provider.

For example, your network family doctor says

you need to see another doctor and

recommends a non - network doctor. It is your

choice; you decide whether to go to the

recommended non - network doctor or to ask

your doctor fo r another recommendation to a

network doctor. In this example, even

though your family doctor is a network

doctor, you will receive non - network

benefits if you go to the recommended non -

network doctor .

2. Sometimes the health care professional

you need to see is not in the network. You

receive non - network benefits when you use

non - network providers, even if no network

provider is available .

6 . From an early age, Petitioner was plagued with symptoms

of t emporomandibular j oint (TMJ) disorder. When sh e was seven

or eight years old, Petitioner began to experience clicking in

her jaw, and her jaw would occasionally lock. The symptoms soon

abated.

7 . Whil e she was in six th grade, Petitioner was fitted for

orthodontic braces. The braces were removed wh en she was 12 or

13 years old .

8 . When Petitioner was in he r early teens, the clicking in

her jaw reappeared. The clicking was now accompanied by pain in

her jaw muscles , which was likened to that experienced from a

migraine headache.

9 . Petitioner w as referred to an oral surgeon regarding

her jaw symptoms. The surgeon recommended a course of physical

therapy for her jaw, and placed her on a diet that eliminated

foods that were Ðchewy.Ñ Despite those measures, PetitionerÓs

jaw began to periodically lock open.

10 . At the age of 16, Petitioner had her wisdom teeth

removed. While that procedure resulted in a cessation of the

locking, Petitioner could only open her mouth about one - quarter

of the way. She was also prescribed Tylenol #3, which containe d

codeine, for pain.

11 . At the age of 16 or 17, Petitioner was given splints

to keep her jaw in alignment. Petitioner was clenching her

teeth so hard in response to the pain, that she broke several

splints during the first year that she had them.

12 . By the time she was 19 years old , PetitionerÓs

headaches were Ðout of control.Ñ She was referred to the facial

pain center at the University of Florida, where she was fitted

with custom - made splints. She was provided with a course of

physical therapy, and was pr e scribed muscle relaxers. When she

returned home from college for the summer, she did the

recommended physical therapy, which was effective in re lieving

her symptoms for a few months.

13 . Petitioner was subsequently referred to Dr. Widmer, a

p hysician at the University of Florida. Dr. Widmer performed an

arthrocentesis, by which a steroid solution was injected into

PetitionerÓs temporomandibular joint s . The procedure was

ineffective.

14 . By 2006, when Petitioner was 23 years old , the openin g

of her mouth began to be accompanied by a ÐsquishingÑ noise.

Dr. Widmer referred Petitioner to Dr. Margaret Dennis.

15 . Dr. Dennis ordered an MRI of PetitionerÓs jaw to

determine if there was any bone damage. The MRI revealed that

the bones of the te mporomandibular joint were degrade d , and that

the disk material was calcified. Dr. Dennis increased the

dosage of PetitionerÓs pain medications to handle the pai n

associated with her condition .

16 . After a period of time, and with Petitioner having

lit tle relief from her symptoms, Dr. Dennis referred her to

Dr. Mark Piper , a physician who is board - certified in o ral and

m axillo - facial s urgery . Dr. Piper maintains his office in

Tampa, Florida.

17 . Petitioner had her first appointment with Dr. Piper i n

August 2009.

18 . Dr. Piper ordered a level 3 MRI, which produced a

clearer picture than her earlier MRI , as well as a CAT scan. He

took imprints of P etitionerÓs teeth, and performed a physical

examination of the bones of PetitionerÓs jaw. The results of

the imaging and the physical exam showed severe and active

degeneration of PetitionerÓs temporomandibular joints ,

especially the right joint .

19 . To remedy PetitionerÓs physical condition, Dr. Piper

recommended a bilateral arthroplast y of PetitionerÓ s jaw,

consisting of a fat graft to the right temporomandibular joint,

and a procedure involving the disk tissue to the left

temporomandibular joint. Given the exhaustion of more

conservative forms of treatment, arthroplasty was, by this

point, appropriat e and medically necessary for the resolution of

PetitionerÓs condition.

20 . On August 25, 2009, Dr. Piper provided Petitioner with

a statement summarizing his diagnosis, and providing an

explanation of his recommended course of action.

21 . Petition er provided Dr. PiperÓs statement to BCBSF to

explain the necessity for her proposed out - of - network treatment.

T he evidence suggests that Petitioner provided the CPT codes for

the recommended procedures at issue .

22 . CPT codes are a system by which med ical services are

assigned numbers to describe those services, and are used by

insurers to establish a uniform schedule of reimbursement. On a

case - by - case basis, the numbers are provided by medical service

providers to describe the services they have ren dered.

23 . Respondent maintains a business record of all

communications between it and its cu stomers . On August 27,

2009, those records reflect that a telephonic request for

information was received either from or regarding Petitioner.

The notation r egarding the request for information stated, in

pertinent part:

PRICING FOR PROC CODES 21240 AND 69990

RELATED TO TREATMENT OF TMJ NEEDED, PROV IS

62468....ALLOWANCES ARE 1168.09 AND 252.53

24 . Petitioner acknowledged that she received the

information regarding the rate s , but understood th e rates to be

estimated amount s , and not official because the person with whom

she spoke could not give final figure s over the tele phone.

25 . Later on August 27, 2009 , RespondentÓs records reflect

that a second telep honic request for information was received

either from or regarding Petitioner. The notation regarding the

request for information stated, in pertinent part:

MEMBER S REQUESTING TO SPK WITH THE V PC R

[Voluntary Pre - coverage Review] AREA AS SHE

WANTS PRIOR APPROVAL OF CODES 21240 AND

69990 FOR THE TREATMENT OF TMJ....I ADVISED

HER OF THE PROCESS AND TO GO AHEAD AND

SUBMIT THE LMN [Letter of Medical Necessity]

AND SUPPORTING DOCS IF THE NON PAR PROV IS

UNWILLING TO CALL OUR OFFICE..I EXPLAINED

THAT THE DET WO ULD BE MADE AND IF ADDTLS

DOCS ARE REQD, THIS WOULD BE ADVISED ALSO,

ADV MEMBER SHE CAN WITH FAX OR MAIL TO AD ON

THE BACK OF INS CARD.

26 . RespondentÓs records reflect no further telephonic

inquiries regarding Petitioner until October 19, 2009.

27 . Petitioner scheduled her surgery with Dr. Piper for

September 16, 2009.

28 . Petitioner testified that approximately one week prior

to the scheduled surgery, BCBSF sent an e - mail to Peti ti oner

providing her with the name of a network provider in

Jackso nville who could perform the surgery necessary to resolve

her TMJ issues. She further testified that she contacted the

network provider Ós office, and was advised by a Dr. Milton that

the medical group could not perform the surgery . Petitioner

testified t hat she advised BCBSF of that information, and

advised BCBSF that there was no one in - network that could

perform the surgery. A copy of the e - mail was not provided, nor

was there evidence to otherwise corroborate the described

events. Therefore, no findi ng can be made as to that alleged

series of communications.

29 . Respondent maintains a list of network health care

providers by specialty type and location . The list is available

on - line. The list include s a number of oral and maxillofacial

surgeons lo cated in the Jacksonville area. However, one cannot

determine from the list whether a provider is capable of

performing a particular procedure under the specialty.

30 . The evidence demonstrates that Dr. Piper is an

accomplished oral and maxillofacial su rgeon , with particular

expertise in disc removal and fat graft placement surgery for

the temporomandibular joint. However, even if Dr. Piper is the

surgeon most qualified to perform the procedure , that does not

mean he is the surgeon singularly qualified to perform the

procedure .

31 . Dr. Imray testified that he has referred patients for

bilateral arthroplastic procedures on many occasions. His

referrals were generally to oral and maxillofacial surgeons

practicing at teaching centers in Jacksonville and Gainesville.

Although he could not testify whether such surgeons were in the

State EmployeesÓ PPO network without consulting his PPO

reference book, he could recall no instance of having had to

refer a patient to an out - of - network provider, Ðbecause most of

the teaching centers take most of the plans.Ñ

32 . The evidence in this case failed to demonstrate that

there were no network providers capable of performing the

procedures medically necessary for the resolution of

PetitionerÓs TMJ issues.

33 . Having concluded that Dr. Piper afforded her with the

greatest likelihood for a successful outcome, Petitioner

proceeded with the surgery as scheduled . After a recovery

period of two years, which included braces to adjust her teeth

to fit her repaired and aligned temporomandibular joints, the

surgery has proven to be a complete success. Petitioner

testified convincingly that the surgery was a life - changing

event .

34 . The total cost to Petitioner for the surgical and

immediate post - operative procedur es was $30,005.00.

35 . In November, 2009, Petitioner began the process of

filing her claim with BCBSF . After some difficulties, the

submission of the claim was completed in January, 2010. The

amount billed to BCBSF was $29,976.00. The bulk of the charge,

in the amount of $24,650.00, was for the procedure identified by

Dr. Piper as CPT Code 21240. The documentation submitted

clearly indicated -- both by the description of the CPT Code

21240 procedure as ÐBilateral TMJ ArthroplastyÑ and by the

list ing of the modifier code Ð50Ñ, which was the code assigned

for procedures that were bilateral -- that the arthroplasty

procedure was bilateral.

36 . On March 11, 2010, BCBSF notified Petitioner that it

would reimburse her medical expenses related to the s urgery in

the amount of $1,5 26.57 . That amount included $1,168.09 for the

arthroplasty (CPT Code 21240), and $358.48 for the surgical

splint (CPT Code 21085). BCBSF indicated that it would not pay

the $1,650.00 charge for the operating microscope (CPT Co de

69990) on the basis that the charge was incidental to the

primary arthroplasty procedure, and therefore included in the

$1,168.09 allowance for that procedure. BCBS F also denied

payment for a ZZ Ther abite (CPT Code 99070).

37 . The reimbursement amou nt was calculated by applying

the CPT Code s provided by Dr. Piper to the BCBSF fee schedule.

The amount was then further adjusted by the non - network payment

allowance to reach the final reimbursable amount. The process

is mechanical, and involves no exer cise of discretion. In that

regard, the reimbursement for the arthroplasty was identical to

the estimate provided to Petitioner on August 27, 2009.

38 . The evidence demonstrates that the amount s paid to

Petitioner for CPT Code 21240 procedures and the CPT Code 21085

surgical splint were accurately derived through application of

the BCBS F fee schedule allowance to the procedure codes provided

by Dr. Piper . However, as to the arthroplasty procedure, the

evidence further demonstrates that the amount paid was based on

a single procedure.

39 . T he arthroplasty performed by Dr. Piper was a

bilateral procedure, which was clearly disclosed on the claim

form. According to Kevin Tincher, BCBSFÓs senior manager of

coding and professional payment, Petitioner is entitled to

reimbursement for both procedures, with the reason given for not

paying for both being Dr. PiperÓs failure to bill each part of

the bilateral procedure on separate lines of the claim form.

Given the lack of any instruction requiring that the t wo sides

of a single bilateral procedure be billed on separate lines,

especially given the application of the modifier code Ð50Ñ to

indicate a bilateral procedure, the information provided on the

claim form was neither deficient nor in error.

40 . When tw o procedures of the same type are performed on

the same day, the BCBSF fee schedule calls for reimbursement for

the s econd procedure at a rate of 50 percent of the allowance

for the first procedure. Under that schedule, Petitioner should

have been reimbur sed an additional $58 4 .05 , i.e., 50 percent of

the $1,168.09 allowance for the first CPT Code 21240 procedure .

41. The evidence demonstrates that the Therab ite device

(CPT Code 99070) was Ðappropriate and acceptableÑ in

Petit ionerÓs case. Thus, the devi ce was medically necessary

under the circumstances. Petitioner should have been

reimbursed, at the non - network rate, for that device.

42 . During the hearing, Jessica Bonin, BCBSFÓs Critical

Inquiry Analyst, admitted that the post - operative CT scan -- CPT

Code 70486 -- in the amount of $301.93, should have been paid,

but that the claim had not been reprocessed by BCBSF.

Respondent further admitted in its Proposed Recommended Order

that payment in the amount of $ 301.93 should be made for the

post - operative CT scan. It is so found.

43 . Petitioner initiated a Level I appeal with BCBS F . She

provided BCBSF with as much of her medical history as she could

locate, a list of medications, and all of the records,

photographs, and X - rays that she could access. S he also

provided a letter from Dr. Piper, dated March 18, 2010, in which

he detailed the services provided to Petitioner. Dr. PiperÓs

description suggests that the services provided to Petitioner

were extensive, but did not suggest that the procedure itse lf

varied from the procedure described in CPT Code 21240 . However,

Dr. Piper did reaffirm that the surgery was a bilateral

procedure involving both of Petitioner Ó s temporomandibular

joints.

44 . BCBSF did not change its decision as a result of the

Leve l I Appeal .

45 . On May 14, 2010, Petitioner filed a Level II Appeal

with Respondent. On June 16, 2010, the Level II Appeal was

denied.

CONCLUSIONS OF LAW

46 . The Division of Administrative Hearings has

jurisdiction over the parties and the subject matter of this

proceeding pursuant to s ections 120.569 and 120.57(1), Florida

Statutes (2011) .

47 . Respondent is the agency charged by the legislature

with the duty to oversee the administration of the State Group

Insurance Program, including the group disability insurance

program.

48 . Petitioner , as the party asserting the right to

payment of medical expenses under the State EmployeesÓ PPO Plan,

has the burden of proving by a preponderance of the evidence

that her medical expenses qualified for cover age under the

program. If she is able to do so, the burden shifts to

Respondent to prove that the expenses were not covered due to

the application of a policy exclusion. Herrera v. C.A. Seguros

Catatumbo , 844 So. 26 664, 668 (Fla. 3d DCA 2003); State

Com prehensive Health Ass Ón v. Carmichael , 706 So. 2d 319, 320

(Fla. 4th DCA 1997).

49 . Insurance contracts are to be construed in accordance

with the plain language of the p olicy , with any ambiguity

construed against the i n surer, and in favor of coverage. U.S.

Fire Ins. Co. v. J.S.U.B., Inc. , 979 So. 2d 871, 877 (Fla.

2007) ; Kohl v. Blue Cross & Blue Shield of Fla., Inc. , 988 So.2d

654, 658 (Fla. 4 th DCA 2008) . However, provisions of a contract

of insurance that are clear and unambiguous, including those

that constitute exclusions from coverage, should be enforced

a ccording to its terms. Bonich v. State Farm Mutual Automobile

Insurance Company , 996 So. 2d 942, 943 (Fla. 2d DCA 2008).

50 . Section 110.123 , entitled State Group Insurance Plan,

describes t he powers and duties conferred on Respondent, in

pertinent part, as follows:

(5) DEPARTMENT POWERS AND DUTIES. Ï The

department is responsible for the

administration of the state group insurance

program. The department shall initiate and

supervise the program as established by this

section and shall adopt such rules as are

necessary to perform its responsibilities.

To implement this program, the department

shall, with prior approval by the

Legislature:

(a) Determine the benefits to be provided

and the contributions to be required for the

state group insurance program . Such

deter minations, whether for a contracted

plan or a self - insurance plan pursuant to

paragraph (c), do not constitute rules

within the meaning of s. 120.52 or final

orders within the meaning of s. 120.52. Any

physicianÓs fee schedule used in the health

and accid ent plan shall not be available for

inspection or copying by medical providers

or other persons not involved in the

administration of the program. . . .

* * *

Final decisions concerning . . . covered

benefits under the state group insurance

program sha ll not be delegated or deemed to

have been delegated by the department.

51 . The evidence demonstrates that Petitioner Ós medical

expenses qualified for coverage under the Plan. Thus,

Petitioner met her initial burden of proof.

52. Petitioner failed t o prove the essential allegation of

her Petition, i.e., that ÐBCBSF inappropriately classified the

surgery that I underwent, in violation of its plan documents, as

some other kind of procedure than the one I had, which had a

much lower allowance.Ñ Rather, the evidenc e clearly

demonstrates that Dr. Piper performed services consistent with

th ose described in CPT Code 21240 and CPT Code 21085 and that

Respondent reimbursed Petitioner consisten t with the fee

schedule for those procedure code s .

53 . Though not technically in the nature of an exclusion

from coverage, the burden of proving that the reimbursement paid

to Petitioner for her qualified medical expenses was the correct

amount under the terms of the Plan lies with Respondent.

54 . Respondent has pro ven, by a preponderance of the

evidence, that the decision by BCBSF, as RespondentÓs contacted

third - party administrator , to reimburse Petitioner for CPT Code

21240 services by a non - network provider in the amount of

$1,168.09 , to reimburse Petitioner for CPT Code 21085 services

by a non - network provider in the amount of $358.48 , and to deny

reimbursement of CPT Code 69990 services on the basis that the

charge was incidental to the primary procedure , w as a correct

application of the benefits and fee schedul e under the Plan .

55 . The evidence supports a conclusion that BCBSF failed

to properly reimburse Petitioner for the full bilateral

procedure , and for the post - operative CT sca n in the amount of

$584.05 and $301.93 , respectively .

56 . The evidence also supports a conclusion that BCBSF

failed to properly reimburse Petitioner for the ZZ Thera bite,

which was a medically appropriate and necessary device. Payment

for that devic e should be at the non - network rate.

RECOMMENDATION

Based on the foregoing Find ings of Fact and Conclusions of

Law, it is

RECOMMENDED:

That the Department of Management Services enter a final

order finding that Petitioner is ent itled to additional

reimbursement for her medical expenses as set forth herein . 1/

DONE AND ENTERED this 23rd day of August , 2012 , in

Tallahassee, Leon County, Florida.

S

E. GARY EARLY

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 23rd day of August , 2012 .

ENDNOTE

1/ In her Proposed Recomme nded Order, Petitioner suggests that

the undersigned should award attorneyÓ s fees under section

120.595. No motion for fees has been filed as required for such

a determination pursuant to section 120.595(2). Thus, no ruling

as to the basis for such an award is made herein.

COPIES FURNISHED :

Brian J. Lee, Esquire

644 Cesery Boulevard, Suite 250

Jacksonville, Florida 32211

Sonja P. Mathews, Esquire

Department of Management Services

Office of the General Counsel

4050 Esplanade Way, Suite 260

Tallahassee, Florida 32399

Jason Dimitris, General Counsel

Department of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399 - 0950

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions

to t his Recommended Order should be filed with the agency that

will issue the Final Order in this case.