CONTACTS 

SUBJECTS
Treatment Clinical Study Cetuximab Carboplatin Drug Trial Kaiser UCS

5603 -
5603 -    ..
5604 - Summary/Objective
5605 -
560501 - Follow up ref SDS 21 0000. ref SDS 20 0000.
560502 -
560503 - Millie submitted a letter to Kaiser that explains continuing delay
560504 - getting treatment for IBC, ref SDS 0 YF8U, and requests authorization
560505 - for treatment of rising symptoms. ref SDS 0 BA9Y  Arlette expedited
560506 - resolution of the problem. ref SDS 0 UE4O  Millie took a short
560507 - vacation to give Kaiser time to resolve authorization issues, and
560508 - schedule treatment for IBC at UCSF. ref SDS 0 KX9H  Jackie called
560509 - later and said UCSF is now satisfied that the problem is resolved.
560510 - Doctor Rugo will schedule a meeting with Millie.  The doctor wants
560511 - Millie to have another CT test for a better baseline to evaluate
560512 - effectiveness of treatments. ref SDS 0 PQ4Q  In the late afternoon,
560513 - Pam reported that Kaiser's Authorization Department submitted via FAX
560514 - to UCSF documentation of Kaiser's authorization for UCSF to treat
560515 - Millie, and culminating many hours of consultations with Medicare.
560516 - ref SDS 0 6S6L  Pam generously donated personal time to call Millie in
560517 - Seattle to give her the good news. ref SDS 0 6T40
560518 -
560519 -        [On 070125 UCSF schedules Millie for treatment on 070131.
560520 -        ref SDS 22 YF8U
560521 -
560522 -
560523 -
560525 -  ..
5606 -
5607 -
5608 - Progress
5609 -
560901 - Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare
560902 - Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix
560903 - Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix
560904 -
560905 - Follow up ref SDS 21 YF8U, ref SDS 20 YF8U.
560906 -
560907 - Millie submitted ref DIT 1 0001 to Arlette, because the doctor is on
560908 - vacation this week, reported yesterday. ref SDS 21 LP4L  Margaret at
560909 - UCSF asked Millie for help yesterday on 070123 getting action from
560910 - Kaiser on payment authorization. ref SDS 21 LC7I  Millie sent a letter
560911 - to her doctor at Kaiser, as requested by UCSF, ref SDS 21 J94L, and
560912 - then learned the doctor is on vacation.  Jackie called a little later
560913 - on 070123, ref SDS 21 J94O, and suggested Millie submit a more
560914 - detailed letter to Kaiser explaining urgency to solve the problem.
560915 - ref SDS 21 FS33
560917 -  ..
560918 - Millie's letter to Arlette at Kaiser says...
560919 -
560920 -    1.  We seem to be having difficulty getting treatment at UCSF
560921 -        prescribed by [my doctor] during the meeting on 070105.
560922 -        ref DIT 1 0001
560924 -         ..
560925 -    2.  At that time on 070105, Doctor Johnson reported having made
560926 -        arrangements with Doctor Rugo at UCSF for me to get treatment
560927 -        of worsening IBC.  He said that Kaiser does not have the kind
560928 -        of treatment that UCSF can provide, similar to when he
560929 -        prescribed radiation and sent me to Mt Diablo for treatment.
560930 -        In that case, he just told me to report to Doctor Moini on a
560931 -        particular date.  I did that and got radiation treatment.
560932 -        ref DIT 1 3364
560934 -         ..
560935 -    3.  This time he said to report to Doctor Rugo at UCSF for
560936 -        treatment.  I did that last Friday, on 070119.  Doctor Rugo's
560937 -        assistant Jackie said Kaiser has not completed arrangements, so
560938 -        treatment was delayed. ref SDS 19 AS96  Jackie did a great job
560939 -        working with Kaiser to resolve the problem, and said that
560940 -        Doctor Rugo and [my primary care physician at Kaiser] want me
560941 -        to have treatment NLT today to arrest rising symptoms and to
560942 -        use the PET/CT baseline test for the clinical trial protocol.
560943 -        ref SDS 19 AS5H, ref DIT 1 3377
560945 -  ..
560946 - Millie mentioned the risk of rising medical cost in a letter to her
560947 - doctor at Kaiser, after Margaret called from UCSF on 070123.
560948 - ref SDS 21 SX5W
560950 -  ..
560951 - Millie's letter to Arlette at Kaiser continues...
560952 -
560953 -    4.  After I got back home from going to UCSF in the City, I
560954 -        notified Doctor Johnson of the problem.  He sent a letter late
560955 -        on 070119 saying he signed the authorization, so everything was
560956 -        good to go this week. ref SDS 19 4R4M  However, on Monday,
560957 -        [actually on Tuesday, 070123] Jackie called and said I cannot
560958 -        come in for treatment, because UCSF has still not received the
560959 -        authorization number from Kaiser. ref SDS 21 4Q54  I notified
560960 -        Doctor Johnson again.  He said [on 070119] there was confusion
560961 -        at Kaiser with new procedures, ref SDS 19 LW9N, but the problem
560962 -        was fixed by communications [on 070122] he had with Kaiser's
560963 -        referral system. ref SDS 20 PN4I, ref DIT 1 1E7I
560965 -         ..
560966 -    5.  Yesterday, I got a call from Margret Rubino.  She works with
560967 -        Jackie in Doctor Rugo's office at UCSF coordinating Clincial
560968 -        Trials. ref SDS 21 MW4H  Margret did a great job facilitating
560969 -        my visit to UCSF for examination by Doctor Benz on 060821,
560970 -        which you recommended in your letter on 060809. ref SDS 3 3J4O
560971 -        ref DIT 1 3392
560973 -         ..
560974 -    6.  In the call yesterday, Margaret was again very helpful
560975 -        explaining that for some reason UCSF has not received an
560976 -        authorization number from Kaier, which [my doctor] signed on
560977 -        070119, and so I cannot get treatment. ref SDS 21 3S3J
560978 -        Margaret explained that she or someone on Doctor Rugo's team
560979 -        tried to resolve the matter by calling Medicare.  They were on
560980 -        hold for 20 minutes or so, then got the famous message... "If
560981 -        you would like to make a call, please hang up and dial back."
560982 -        They tried again, and had the same experience, ref SDS 21 MW5Y,
560983 -        with the result that UCSF has gone the extra mile to implement
560984 -        [my doctor's] prescription for my treatment, but this has not
560985 -        worked. ref DIT 1 3397
560987 -         ..
560988 -    7.  Jackie called back about 30 minutes later, and explained that
560989 -        somehow or other UCSF needs an authorization, and without out
560990 -        it the only way I can get treatment is to personally sign
560991 -        something that would obligate me for expenses above my premiums
560992 -        for insurance which I already pay to Kaiser. ref SDS 21 J94O
560993 -        Since the cost of drugs and related issues are paid by the drug
560994 -        trial process, UCSF requires payment for standard of care.
560995 -        ref DIT 1 4F9O
560997 -         ..
560998 -    8.  Standard of care was discussed in correspondence between Doctor
560999 -        Rugo and [my doctor] on 061230.  At that time, [my doctor] told
561000 -        Doctor Rugo that Kaiser would pay for any costs not covered by
561001 -        the trial. ref SDS 7 3X6K, ref DIT 1 WF4M
561003 -         ..
561004 -    9.  I am very grateful for everyone's help.  Doctor Rugo and her
561005 -        staff, including Jackie, and Margaret have been wonderful. [My
561006 -        doctor] came in on vacation this past Monday to order
561007 -        additional blood work UCSF requested for the trial. ref SDS 20
561008 -        LX6V  I sent him a letter yesterday explaining the current
561009 -        problem, ref SDS 21 J94L, but got a response back that he is on
561010 -        vacation. ref SDS 21 LP4L ref DIT 1 3358
561012 -         ..
561013 -   10.  I realize that  Michelle in your office has worked to resolve
561014 -        the problem.  She said you will be in the office today, so I am
561015 -        asking for your assistance again to try and get things set up
561016 -        for my chemotherapy treatment at UCSF in the same way that
561017 -        things went so smoothly at Mt Diablo for radiation treatments.
561018 -        Since Doctor Johnson has signed the authorization, can I get a
561019 -        copy to take to UCSF, or is there some other way to get UCSF
561020 -        the authorization number they require. ref DIT 1 AG5O
561022 -         ..
561023 -   11.  I am sending a copy to Margaret and Jackie to thank them for
561024 -        extra effort, and to further coordinate in case I have not
561025 -        explained the problem correctly. ref DIT 1 00W2
561026 -
561027 -
561029 -  ..
5611 -
5612 -
5613 - 1045
5614 -
561401 - Millie Leaves Town for Vacation in Seattle
561402 -
561403 - Took Millie to the airport in Oakland, and she departed on a vacation
561404 - visiting friends in Seattle for 4 days until 070127, per planning
561405 - yesterday to get away from the tensions of medical management,
561406 - ref SDS 21 PUPV, and implementing original planning reported to UCSF
561407 - on 070116. ref SDS 15 VQ3G
561408 -
561409 -
561410 -
561412 -  ..
5615 -
5616 -
5617 - 1628
5618 -
561801 - Arlette Expedites Resolution with Kaiser Outside Authorization Dep
561802 -
561803 - After leaving on vacation, Millie received ref DRT 1 0001 from Arlette
561804 - responding to her letter, ref DIT 1 0001 earlier this morning,
561805 - relating patient history on delay getting treatment at UCSF, per
561806 - above, ref SDS 0 YF8U, and asking for Arlette's help. ref SDS 0 BA9Y
561808 -  ..
561809 - Arlette says in her reply...
561810 -
561811 -        I forwarded [Millie's letter today, per above, ref SDS 0 6H4J]
561812 -        to our Outside Authorization Dept.  Barbara Gin s/w a Lisa at
561813 -        UCSF business office this am and sent her the statement about
561814 -        senior advantage/Medicare.  They have to bill medicare.  It is
561815 -        the law!  They can not refuse.  I also s/w a Barbara and gave
561816 -        her your phone number and Dr.  Rugo's phone number.  She will
561817 -        be on it!  UCSF is not wanting to do their part.  I hope this
561818 -        gets straightened out soon! ref DRT 1 0001
561819 -
561820 -            [...below, Arlette's expediting successful; Jackie at UCSF
561821 -            called and left message UCSF ready to treat Millie.
561822 -            ref SDS 0 PQ4Q
561824 -             ..
561825 -            [...below, Pam in Kaiser Authorization Department reports
561826 -            Barbara worked with Medicare to solve the problem and that
561827 -            Kaiser submitted an authorization number to UCSF.
561828 -            ref SDS 0 6S6L
561830 -             ..
561831 -            [On 070125 UCSF schedules Millie for treatment on 070131.
561832 -            ref SDS 22 YF8U
561834 -             ..
561835 -            [On 070126 commended Arlette for resolving authorization
561836 -            problem quickly. ref SDS 23 YF8U
561838 -             ..
561839 -            [On 070309 Arlette's schedule change; can no longer
561840 -            coordinate case management for the doctor, because there
561841 -            isn't enough time to get content transferred into the
561842 -            doctor's computer program. ref SDS 24 VP73
561843 -
561844 -
561845 -
561847 -  ..
5619 -
5620 -
5621 - 1210
5622 -
562201 - Authorization Problem Solved UCSF Requires Another PET/CT Test
562202 - UCSF Ready to Give Millie Treatment Requires Another PET/CT Test
562203 -
562204 - After returning from taking Millie to the airport, received telephone
562205 - message from Jackie saying UCSF has resolved authorization problems,
562206 - so that Millie can now get treatment.
562207 -
562208 -        [On 070125 UCSF schedules Millie for treatment on 070131.
562209 -        ref SDS 22 YF8U
562211 -  ..
562212 - Doctor Rugo wants Millie to get another PET/CT test, as discussed with
562213 - Jackie yesterday on 070123. ref SDS 21 J438
562214 -
562215 -        [On 070125 Doctor Rugo orders updated CT test to begin new
562216 -        treatments at UCSF; request CT test for pulmonary embolism.
562217 -        ref SDS 22 Z24H
562218 -
562219 -
562220 -
562221 -
562222 -
562224 -  ..
5623 -
5624 -
5625 - 1221
5626 -
562601 - Called and left message for Jackie advising that Millie is traveling
562602 - until Saturday.
562603 -
562605 -  ..
5627 -
5628 -
5629 - 1232
5630 -
563001 - Called Millie on her cell phone.  She is still in the airport at
563002 - Oakland.  Advised of evident good news from Jackie.  Explained UCSF
563003 - wants another PET/CT test.
563005 -  ..
563006 - Millie was elated to have this finally solved.
563007 -
563008 -
563010 -  ..
5631 -
5632 -
5633 - 1638
5634 -
563401 - Kaiser Authorization Approved for Millie Treatment of Advancing Cancer
563402 -
563403 - Pam called from Kaiser.  She is the representative in Kaiser's
563404 - Referrals Authorization Department mentioned in Michelle's letter
563405 - yesterday morning, ref SDS 21 575F, and referenced in Arlette's letter
563406 - today explaining Kaiser's efforts in the Oncology Department to
563407 - expedite authorization for Millie's treatment at UCSF, per above.
563408 - ref SDS 0 UE4O
563410 -  ..
563411 - Pam said they solved the problem getting authorization from Medicare
563412 - yesterday afternoon for Kaiser's referral to UCSF.  This seems to
563413 - confirm understandings from Jackie's earlier telephone message
563414 - indicating UCSF can now schedule Millie to meet with Doctor Rugo, and
563415 - then get treatment that has been delayed now nearly 2 months, per
563416 - above. ref SDS 0 PQ4Q
563417 -
563418 -        [On 070125 UCSF schedules Millie for treatment on 070131.
563419 -        ref SDS 22 YF8U
563421 -  ..
563422 - Pam related that her colleague, Barbara talked for about 8 hours over
563423 - the past several days with Kaiser's Medicare branch.  This aligns with
563424 - Arlette's letter to Millie earlier today on expediting resolution, per
563425 - above. ref SDS 0 UE4O
563427 -  ..
563428 - Pam seemed to indicate that Barbara was on hold for long periods
563429 - before making contact, similar to experience at UCSF reported
563430 - yesterday. ref SDS 21 MW5Y  Barbara and the Medicare representatives
563431 - eventually worked out a solution to support the doctor's prescription
563432 - on 070105 for Millie to get treatment she needs at UCSF.  Pam
563433 - indicated that yesterday afternoon Barbara submitted via fax to Lisa
563434 - authorization required by UCSF and approved by the primary care
563435 - physician on 070119. ref SDS 19 4R4M
563436 -
563437 -        [On 070126 Arlette called and confirmed that Kaiser submitted
563438 -        referral authorization for Millie to get treatment at UCSF.
563439 -        ref SDS 23 F179
563441 -  ..
563442 - Lisa works for UCSF, and was cited in Michelle's letter yesterday for
563443 - collaborating with Pam in Kaiser'a Authorization department.
563444 - ref SDS 21 575F  Lisa was also mentioned in Arlette's letter today,
563445 - per above. ref SDS 0 GD6M
563446 -
563447 -        [On 070125 Jackie reported that UCSF did not receive an
563448 -        authorization from Kaiser, and that Lisa in UCSF's Business
563449 -        Office spent 6 hours talking to Medicare for authorization that
563450 -        UCSF would be paid for treating Millie. ref SDS 22 4Y62
563452 -  ..
563453 - Pam said that Millie does not need Kaiser authorization, because
563454 - Medicare is required to pay for clinical trials.  Pam did not explain
563455 - how getting prescribed treatment at UCSF differs from getting
563456 - prescribed treatent at Mt Diablo, set out in Millie's letter to
563457 - Arlette this morning, per above. ref SDS 0 YF8U
563459 -  ..
563460 - Pam did not explain why Kaiser and Medicare required 8 hours of
563461 - telephone discussion to implement the doctor's prescription for Millie
563462 - to get treatment at UCSF.  The steps and authority in government
563463 - regulations applied in this case, and likely required for future work
563464 - on similar issues are not evident in the record for developing lessons
563465 - learned.
563467 -  ..
563468 - Pam did not explain why after solving the problem yesterday afternoon,
563469 - the patient was not notified until late in the afternoon today, after
563470 - Arlette got involved this morning to expedite the work, per above.
563471 - ref SDS 0 UE4O
563473 -  ..
563474 - Unless this matter can be streamlined to work like the doctor's
563475 - referral for Millie to get radiation treatment at Mt Diablo, reported
563476 - in the letter to Arlette this morning, per above, ref SDS 0 BA3W,
563477 - doctors at Kaiser will be reluctant to prescribe essential treatment
563478 - at UCSF, and UCSF will avoid referrals from Kaiser, resulting in
563479 - higher cost and reduced care for patients.
563481 -  ..
563482 - Asked Pam to call Millie and let her know the hard work that Pam and
563483 - her colleague Barbara have done for Millie.
563485 -  ..
563486 - Millie left town for a short vacation from problems the past few days
563487 - that prevented Millie from getting treatment last Friday, again
563488 - yesterday, and again today, as explained by Jackie at UCSF yesterday.
563489 - ref SDS 21 J94O
563491 -  ..
563492 - Gave Millie's cell phone number to Pam.
563494 -  ..
563495 - Asked Pam to submit a letter confirming the steps Kaiser took to
563496 - complete authorization for Millie's treatment at UCSF.  Pam indicated
563497 - that her boss feels writing up the record in a letter to the customer
563498 - would not be a good use of her time.
563500 -  ..
563501 - Asked Pam for an email address where she can receive a letter
563502 - confirming understandings from the call today.  Pam said her boss does
563503 - not permit staff to receive correspondence from customers to verify
563504 - accuracy of understandings.
563506 -  ..
563507 - Pam advised that her shift at Kaiser has ended, but she will call
563508 - Millie on her cell phone to report good news that Kaiser has resolved
563509 - payment authorization so that Millie can start getting treatment at
563510 - UCSF ordered by the primary care physician.
563512 -  ..
563513 - Thanked Pam for Kaiser's work, and consideration to give Millie
563514 - personal notification.
563515 -
563516 -        [On 070125 UCSF schedules Millie for treatment on 070131.
563517 -        ref SDS 22 YF8U
563518 -
563519 -        [On 070917 Virginia in Kaiser's Medicare Member Services
563520 -        Department said her boss does not permit customer
563521 -        representatives to submit documentation confirming telephone
563522 -        representations with customers, memebers, and patients.
563523 -        ref SDS 25 E16Y
563524 -
563525 -
563526 -
563527 -
563528 -
563529 -
563530 -
563531 -
563532 -
5636 -