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THE SUPERIOR COURT OF THE STATE OF WASHINGTON <br />COUNTY OF KITTITAS <br />JUVENILE COURT DIVISION <br />SUPERIOR COURT JUDGES JUVENILE COURT ADMINISTRATOR <br />JAMES D. KIRKI-LAM <br />��� '1.s rF p KATRINA D. MANKUS <br />� � <br />CHRIS T. HERION o <br />205 W 5TH AVENUE, STE. 211, ELLENSBURG, WA 98926 <br />509-962-7516 FAX 509-962-7667 <br />Request for 1/101h Mental Health/Substance Use Disorder Funds for Out -of -Pocket Treatment Costs <br />We have a youth on criminal supervision that is recommended for inpatient substance use disorder <br />treatment. The family has private insurance through Blue Shield/Blue Cross and have indicated they <br />have an individual out-of-pocket maximum of $5,000, however, the 90-day facility they have been <br />accepted at is out -of -network, and their insurance has quoted out-of-pocket costs around $36,000. The <br />family needs assistance in covering the out-of-pocket expenses. While the youth has been accepted to a <br />90-day facility, the full length of treatment can be adjusted to meet the needs of the youth, which could <br />extend past 90 days. <br />The full amount will depend on length of treatment and may not be known until the treatment stay is <br />complete. <br />This request is on behalf of the family, and reimbursement would be to the family upon receipt of <br />verified expenses, explanation of benefits from their medical insurance, and or other documents as <br />required by the County or the 1/10 Mental Health/Substance Use Disorder Board. <br />Thank you for your consideration. <br />Katrina Mankus <br />Juvenile Court Administrator <br />