CONTACTS 
0202 - UCSF Medical Center                                                                                                                                                O-00000875 0305
020201 - Mr. Robert Zvi Schwartz, MPH                                                                                                                                     O-00000875 0305
020202 - Patient Financial Consultant
020204 - Patient Financial Services

SUBJECTS
UCSF Claim $10K Not Justified Kaiser Referral Patient Did Not Self-r

3203 -
3203 -    ..
3204 - Summary/Objective
3205 -
320501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
320502 -
320503 -
320504 -
320505 -
320507 -  ..
3206 -
3207 -
3208 - Progress
3209 -
320901 - Millie submitted ref DIT 1 0001 to Doctor Rugo at UCSF with copies to
320902 - Jackie, Bob Schwartz, in the accounting department, and to the primary
320903 - care physician at Kaiser.  This follows up the letter, ref DIP 1 0001
320904 - to Jackie at UCSF on 070831, ref SDS 13 G15I, for distribution to
320905 - Doctor Rugo, and copies to Bob Schwartz in UCSF accounting, and to
320906 - Arlette for distribution to the primary care physician at Kaiser, and
320907 - which confirmed understandings from meeting at UCSF the day before on
320908 - 070830, ref SDS 12 0001, when Bob explained UCSF invoices for
320909 - annualized claim of $10K is not correlated to any services for
320910 - treatment in the clinical trial, ref SDS 12 WU5N, and conflicts with
320911 - Kaiser's agreement to pay for any costs not covered by the clinical
320912 - trial. ref SDS 12 T247
320913 -
320915 -  ..
320916 - CA 15-3 28 Best Result 7 Years Clinical Trial Treatment Effective
320917 -
320918 -
320919 - Millie says to Doctor Rugo...
320920 -
320921 -    1.  Thanks to you and [the primary care physician] at Kaiser, I am
320922 -        at last about to leave for vacation in a few days after
320923 -        treatment on Thursday.  I return in time to start a new cycle
320924 -        of treatment on Sep 20th, when I am scheduled to see you and
320925 -        your team. ref DIT 1 0001
320927 -         ..
320928 -    2.  If you haven't heard, Jackie reported my last CA 15-3 has
320929 -        dropped to 28, the lowest in 7 years, and I feel great.  IBC
320930 -        rash has subsided substantially since your initial examination
320931 -        on Jan 30th, 2007, with the 1st treatment on Feb 1.  Of course
320932 -        the rash persists, so my understanding is that treatment needs
320933 -        to continue. ref DIT 1 FE55
320934 -
320936 -  ..
320937 - Billing Dispute Good Offices Clinical Director Request Assistance
320938 - Good Offices Clinical Director Request Assistance Billing Dispute
320939 - Request Assistance Billing Dispute Good Offices Clinical Director
320940 -
320941 -
320942 -    3.  Unfortunately, I must call on your good offices to facilitate
320943 -        resolution of a payment issue presented within the past few
320944 -        weeks.  Last week on August 30th, while I was getting
320945 -        treatment, Rod met with Bob Schwartz in the UCSF accounting
320946 -        office on Harrison Street. ref SDS 12 0001  A letter the next
320947 -        day to Jackie with a copy to Bob, ref DIP 1 GG84, sets out what
320948 -        seems to me an unfair and certainly unexpected expense of about
320949 -        $10K per year for me to get treatment in the clinical trial at
320950 -        UCSF. ref SDS 12 W05N, ref DIT 1 FE62
320951 -
320952 -              [On 070906 Millie submitted interim payment for
320953 -              coinsurance, and affirmed this issues is disputed.
320954 -              ref SDS 14 EB3P
320956 -               ..
320957 -              [On 070906 Doctor Rugo responded confirming Kaiser made
320958 -              the referral and that Medicare rules are muddy.
320959 -              ref SDS 14 UK5M
320961 -               ..
320962 -              [On 070907 primary care physician at Kaiser not familiar
320963 -              with billing issues; told Kaiser's referral to UCSF
320964 -              Medicare issue. ref SDS 15 XH5H
320966 -               ..
320967 -              [On 070909
320968 -
320970 -         ..
320971 -        Doctor Rugo Worked Hard Avoid Unjustified Big Bill to Patient
320972 -
320973 -
320974 -    4.  I know that you personally worked hard to avoid this result, as
320975 -        did [the primary care physician at Kaiser].  You specifically
320976 -        delayed my treatment in order to resolve payment issues with
320977 -        Kaiser so that I would not get stuck with a big bill. [reported
320978 -        on 070130, ref SDS 5 LY9H]  At all times, I understood that all
320979 -        costs for my treatment at UCSF would be covered by the trial
320980 -        program, and by Kaiser. [reported on 061230, ref SDS 2 3X6K,
320981 -        and presented to Bob Schwartz in UCSF accounting on 070830,
320982 -        ref SDS 12 T247]  Now it seems, months later, the "gods" are
320983 -        against us. ref DIT 1 FE66
320984 -
320985 -           [On 070917 Medicare statute Title 42 section 419.40
320986 -           explains coinsurance minimum 20% for participation of
320987 -           private insurance market coverage Medigap secondary,
320988 -           supplemental insurance, ref SDS 16 4Q3I, which must pay
320989 -           for coinsurance. ref SDS 16 IP8L  Medigap must pay for
320990 -           coinsurance on clinical trials. ref SDS 16 LN9W
320991 -
320993 -         ..
320994 -        Emotional Trauma Shock $10K Charges 100 Invoices Statements
320995 -
320996 -        The traumatic part is all the letters I have received recently
320997 -        from Kaiser (now 30+) denying payment to UCSF from the first of
320998 -        the year saying that my clinical trial at UCSF was not
320999 -        authorized by [the primary care physician at Kaiser] [reported
321000 -        on 070823, ref SDS 10 6M4G]  Besides many meetings when the
321001 -        doctor told me to go see you for treatment [e.g., on 070105,
321002 -        ref SDS 3 PK7L, on 070202, ref SDS 7 QO6O, I received a letter
321003 -        from the doctor on January 19th saying he sent the
321004 -        authorization.  He also noted there is confusion at Kaiser on
321005 -        handling new Medicare regulations. ref SDS 4 4R4M, ref DIT 1
321006 -        KB8I
321008 -         ..
321009 -    5.  Discussions with Kaiser staff the past few weeks have yielded
321010 -        an observation that since Medicare allows patients
321011 -        "self-referral," somehow Kaiser's representations are
321012 -        invalidated despite lack of notice to me.  I know that in this
321013 -        case referral arrangements were entirely by Kaiser, and that I
321014 -        was told to go to UCSF for treatment, which has turned out to
321015 -        work medically exactly, as the doctor planned. ref DIT 1 FE67
321016 -
321018 -         ..
321019 -        Voice Message Primary Care Physician Unsure Referral Procedures
321020 -
321021 -
321022 -    6.  By copy to [the primary care physician] at Kaiser, I am noting
321023 -        receipt of his voice message received on August 30th after I
321024 -        returned from UCSF for treatment.  At that time he indicated
321025 -        again that Kaiser's approach to Medicare is confusing, and he
321026 -        is now unsure about procedures. ref DIT 1 FE68
321027 -
321029 -         ..
321030 -        Coinsurance Agreement Interim Payment UCSF Submit Justification
321031 -
321032 -
321033 -    7.  When Rod met with Bob last Thursday in the UCSF accounting
321034 -        office, he agreed I would pay UCSF for something called
321035 -        "co-insurance." ref SDS 12 V373  In order for me to pay this I
321036 -        need an itemized listing of charges, and authority that
321037 -        justifies the charges.  I have been coming to UCSF since
321038 -        February, and every time I check in the attendant tells me I do
321039 -        not owe a co-payment because all costs of clinical trials are
321040 -        paid by the clinical trial.  Why do I owe this and others
321041 -        don't? ref DIT 1 TS4H
321042 -
321044 -         ..
321045 -        UCSF Billings Confusing No Idea What to Pay
321046 -
321047 -
321048 -    8.  The amount varies for unknown reasons not presented in the
321049 -        documents.  Some invoices show $20 or so, and others say $27.
321050 -        I have some that say there is no charge, and at least one
321051 -        recently that says over $200.  Accordingly, I have no idea what
321052 -        to pay nor the basis for making payment.  Bob Schwartz in the
321053 -        meeting on August 30th, seemed to say this "co-insurance" is
321054 -        for office visits.  That sounds like a co-payment.  Since you
321055 -        are running the trial program, could you please clarify.  If I
321056 -        owe a co-payment that should be stated in the beginning, and I
321057 -        will pay as I go, as I do at Kaiser. ref DIT 1 FE73
321058 -
321060 -         ..
321061 -        How Much Clinical Trial Costs Above Insurance Premiums
321062 -
321063 -
321064 -    9.  Most importantly, I need to know how much treatment costs in
321065 -        addition to my insurance payments to Kaiser and to Medicare, so
321066 -        that I can decide whether I can afford the treatment.  I don't
321067 -        have enough money to just give Kaiser a blank check.
321068 -        ref DIT 1 FE74
321070 -         ..
321071 -   10.  Hopefully, this can be reviewed over the next few weeks so we
321072 -        can work toward resolution of confusing regulations.  I have
321073 -        been blessed to have great care from you and your team, backing
321074 -        up [the primary care physician] at Kaiser.  But we need to
321075 -        pause and develop a coordination plan.  So far we are missing
321076 -        justification for extra expenses being billed to me.  Somewhere
321077 -        there is a statute, regulation, policy, implementation
321078 -        memorandum, something, that sets out the basis for charges.
321079 -        ref DIT 1 FE7M
321080 -
321081 -           [On 070917 Medicare statute Title 42 section 419.40 explains
321082 -           coinsurance minimum 20% for participation of private
321083 -           insurance market coverage Medigap secondary, supplemental
321084 -           insurance, ref SDS 16 4Q3I, which must pay for coinsurance.
321085 -           ref SDS 16 IP8L  Medigap must pay for coinsurance on
321086 -           clinical trials. ref SDS 16 LN9W
321088 -            ..
321089 -           [On 070927 Millie found documentation from Kaiser describes
321090 -           coinsurance for "self-referral" to participate in clinical
321091 -           trials for medical research, ref SDS 17 1G4O, which does not
321092 -           apply to clinical trial services for Millie's treatment at
321093 -           UCSF prescribed by Kaiser for routine care. ref SDS 17 1F92
321094 -           Need statutory justification for service provider
321095 -           transferring costs to patient under guise of clinical trial
321096 -           coinsurance. ref SDS 17 RC6M
321098 -            ..
321099 -           [On 071027 letter to UCSF cites UCSF report on 071018 that
321100 -           Millie was "cut loose" to fend for herself back in January,
321101 -           and so must perform contract management in place of Kaiser,
321102 -           ref SDS 18 MA5Q, proposes meeting to develop referral
321103 -           coordination plan, ref SDS 18 TF5J
321105 -            ..
321106 -           [On 071029 letter to Robin Hanson requests UCSF schedule
321107 -           referral coordination meeting to explain billing
321108 -           procedures. ref SDS 19 446F
321110 -         ..
321111 -   11.  By copy I am alerting Bob Schwartz of my feeling.  Please get
321112 -        me the justification and amount of "co-insurance" and I will
321113 -        pay that on Thursday, as discussed last week.  I need to know
321114 -        why I owe this, when I have been told for 8 months that I
321115 -        don't. ref DIT 1 FE7N
321117 -               ..
321118 -              [On 070906 Millie submitted interim payment to UCSF for
321119 -              coinsurance, subject to justification from UCSF.
321120 -              ref SDS 14 EB3P and ref SDS 14 UY6K
321122 -               ..
321123 -              [On 070917 UCSF letter cites CMS section 69.9 to justify
321124 -              coinsurance charges against Millie, ref SDS 16 596Q;
321125 -              review showed this CMS regulation does not support UCSF
321126 -              charges to Millie for coinsurance in this case.
321127 -              ref SDS 16 OH9I
321128 -
321129 -
321131 -         ..
321132 -        Rod Authorized Communicate Case Management
321133 -
321134 -
321135 -   12.  Please submit response to Rod (see address above), who is
321136 -        familiar with the record in this case, and is assisting me with
321137 -        resolution of this matter, so that I can concentrate on getting
321138 -        well. ref DIT 1 FE7O
321139 -
321140 -
321141 -
321142 -
321143 -
321144 -
321145 -
321146 -
321147 -
3212 -