CONTACTS 
0201 - UCSF Medical Center
020101 - Mr. Robert Zvi Schwartz, MPH
020102 - Patient Financial Consultant
020104 - Patient Financial Services

SUBJECTS
Kaiser Senior Advantage Medicare Coverage  Nt Medigap Patient Respon

6003 -
6003 -    ..
6004 - Summary/Objective
6005 -
600501 - Follow up ref SDS 13 0000, ref SDS 12 0000.
600502 -
600503 -
600504 -
600505 -
600507 -  ..
6006 -
6007 -
6008 - Progress
6009 -
600901 - UCSF Substantial Progress Resolving Clinical Trial Payment Issues
600902 -
600903 - Follow up ref SDS 13 EZ5J, ref SDS 12 EZ5J.
600904 -
600905 - Received ref DRT 1 0001 from Bob at UCSF responding to a letter dated
600906 - 070920 to Millie's letter on 070919. ref SDS 13 EZ5J
600908 -         ..
600909 -    1.  I am a bit confused with your last email.   I just rechecked
600910 -        her Medicare coverage on line & it shows that Ms Buck has
600911 -        Kaiser because she assigned her Medicare coverage to Kaiser.
600912 -        Kaiser is not her MediGap coverage and would only make payment
600913 -        if they preauthorized specific medical services at UCSF.  This
600914 -        means the patient is responsible to pay her Medicare
600915 -        coinsurance. ref DRT 1 0001
600917 -  ..
600918 - Bob addresses Millie's understanding that Kaiser has constructive
600919 - Medigap coverage presented in a letter on 070919. ref SDS 13 I53Y
600921 -  ..
600922 - UCSF letter continues...
600923 -
600924 -    2.  A MediGap plan is one where the patient purchases insurance
600925 -        coverage to cover all or part of what Medicare does not cover.
600926 -        ref DRT 1 N66I
600928 -  ..
600929 - Research on 070917 shows Kaiser instructs customers to cancel Medigap
600930 - coverage indicating Kaiser Senior Advantage covers this scope.
600931 - ref SDS 12 EZ56
600932 -
600933 -            [...below, response to UCSF addressing Bob's understanding
600934 -            of insurance coverage flowing from Kaiser's referral for
600935 -            Millie's treatment at UCSF. ref SDS 0 UL8Y
600937 -             ..
600938 -            [On 070927 Kaiser's documentation shows on page 4 that
600939 -            Senior Advantage does not provide supplemental Medigap
600940 -            coverage, ref SDS 16 1F6L, which conflicts with Kaiser's
600941 -            representations that Kaiser Senior Advantage supplemented
600942 -            Medicare, and was all Millie needed to maintain continuity
600943 -            of treatment for cancer provided by Kaiser since 2002.
600944 -            ref SDS 16 4A9J
600946 -             ..
600947 -            [On 070927 Kaiser told Millie in 2004 that Senior Advantage
600948 -            insurance would continue her treatment for cancer.
600949 -            ref SDS 16 H75F
600951 -             ..
600952 -            [On 071018 AARP article reports widespread confusion about
600953 -            differences between Medigap supplemental Medicare policies
600954 -            and HMO insurance coverage due to misrepresentations
600955 -            selling managed care insurance cause beneficiaries to incur
600956 -            significant extra charges. ref SDS 19 CR6T
600957 -
600958 -
600959 -
6010 -

SUBJECTS
Contact UCSF Feel Free on Billing Concerns Questions Confirm Policy

7403 -
740401 -  ..
740402 - UCSF Continued Support Contact for Answers to Billing Questions
740403 -
740404 -
740405 - UCSF letter continues...
740406 -
740407 -    3.  It is good to hear that Ms.  Buck is doing better.  As always,
740408 -        please feel free to contact me with your UCSF billing concerns.
740409 -        ref DRT 1 N66N
740411 -  ..
740412 - This confirms Bob's letter on 070912 offering UCSF support for
740413 - questions on billings to Millie. ref SDS 12 H47I
740414 -
740415 -             [...below, letter thanks Bob and UCSF for good wishes on
740416 -             Millie's successful treatment. ref SDS 0 2A5J
740417 -
740418 -             [On 071009 letter from Bob Schwartz at UCSF reports asking
740419 -             Kaiser to tell the patient not to contact UCSF on billing
740420 -             issues, ref SDS 18 X65I, Millie was called by Kitty Cook
740421 -             at Kaiser who invoked HIPAA for purposes of disclosing
740422 -             private medical information to the patient, ref SDS 18
740423 -             JW7M, and then told Millie that Bob Schwartz refuses to
740424 -             communicate with the patient on resolving billing issues.
740425 -             ref SDS 18 JW59
740426 -
740427 -
740428 -
740429 -
740430 -
7405 -

SUBJECTS
Trust Reliance Doctor Stressful Patient Diagnostics Rising Kaiser Fa

B803 -
B804 - 0301
B80501 -  ..
B80502 - Trust Reliance on Doctor Stressful Patient Diagnostics Rising
B80503 -
B80504 - Submitted letter, ref DIT 1 0001, to UCSF responding to Bob's letter
B80505 - on 070920, received in the record per above. ref SDS 0 EZ5J
B80506 -
B80507 -    1.  Thanks for warm thoughts on Millie in your letter on 070920.
B80508 -        ref SDS 0 N45S, ref DIT 1 0001
B80510 -         ..
B80511 -    2.  Doctor Rugo (UCSF) and [the primary care physician at Kaiser]
B80512 -        have seen Millie through difficult times, so diagnostically she
B80513 -        is doing better than ever. [CA 15-3 drops to 28, on 070831,
B80514 -        ref SDS 9 G15I].  As you might imagine trust and reliance have
B80515 -        become stressful issues.  [The primary care physician] noticed
B80516 -        rising stress on Friday at Kaiser, ref SDS 14 QY5I, and Brigid
B80517 -        observed this the day before at UCSF for examination starting
B80518 -        the next round of treatment. ref SDS 14 BU6H  Hopefully, we can
B80519 -        relieve this with compromise discussed below. ref SDS 0 UM4U,
B80520 -        ref DIT 1 IL6H
B80522 -         ..
B80523 -    3.  As discussed in your office on 070830, Millie did not
B80524 -        self-refer for treatment at UCSF. ref SDS 8 T247  Kaiser
B80525 -        prescribed treatment made arrangements and told her to go to
B80526 -        UCSF. [on 070105, ref SDS 2 PK7L]  Correspondence between
B80527 -        Kaiser and UCSF on 061230 states Kaiser will pay for any cost
B80528 -        not covered by the clinical trial. ref SDS 1 3X6K
B80529 -        Authorization was submitted by Kaiser on 070119, ref SDS 3
B80530 -        4R4M, per the record of our meeting on 070830. ref SDS 8 T247,
B80531 -        ref DIT 1 IL7G
B80532 -
B80533 -           [On 070927 Kaiser's documentation shows on page 4 that
B80534 -           Senior Advantage does not provide supplemental Medigap
B80535 -           coverage, ref SDS 16 1F6L, which conflicts with Kaiser's
B80536 -           representations that Kaiser Senior Advantage supplemented
B80537 -           Medicare, and was all Millie needed to maintain continuity
B80538 -           of treatment for cancer provided by Kaiser since 2002.
B80539 -           ref SDS 16 4A9J
B80541 -            ..
B80542 -           [On 071018 AARP article reports widespread confusion about
B80543 -           differences between Medigap supplemental Medicare policies
B80544 -           and HMO insurance coverage due to misrepresentations selling
B80545 -           managed care insurance cause beneficiaries to incur
B80546 -           significant extra charges. ref SDS 19 CR6T
B80547 -
B80548 -
B80549 -
B80550 -
B80551 -
B806 -

SUBJECTS
Double Dip Financial Engineering Not Justified Kaiser Saves Money Cl

C603 -
C60401 -         ..
C60402 -        Double Dipping Not Justified Kaiser Break on Cost of Drugs
C60403 -
C60404 -        Follow up ref SDS 8 NQ3F.
C60405 -
C60406 -    4.  Kaiser and UCSF have expertise to accomplish fair, just payment
C60407 -        for Millie's care, demonstrated the past 6 years while she has
C60408 -        been treated for cancer under the same surety coverage Millie
C60409 -        has now.  By sending Millie to UCSF, Kaiser gets a break on the
C60410 -        cost of drugs, which [the primary care physician] mentioned on
C60411 -        Friday is a considerable cost savings to Kaiser. ref SDS 14
C60412 -        QY58  There is no reason to double-dip with financial
C60413 -        engineering to get an additional 20% payment [discussed with
C60414 -        UCSF on 070830, ref SDS 8 NQ3F], or whatever it is Kaiser has
C60415 -        calculated in telling UCSF what to bill Millie.  The primary
C60416 -        care physician indicated on Friday that Kaiser and UCSF have
C60417 -        excellent relations. ref SDS 14 CU5K  Doctor Rugo mentioned on
C60418 -        070130 that UCSF always has problems getting payments from
C60419 -        Kaiser, but eventually things work out. ref SDS 5 LY9H  Your
C60420 -        record of negotiations [reviewed on 070823] shows success
C60421 -        getting reasonable payment from Kaiser. ref SDS 7 NN71  You
C60422 -        should try again to get support for the doctor, and to perform
C60423 -        obligations to Millie. ref DIT 1 IL7Q
C60424 -
C60425 -
C60426 -
C605 -

SUBJECTS
Treatment UCSF Clinical Trial Effective Continue with Financial Arra

D803 -
D80401 -  ..
D80402 - Treatment UCSF Effective Continue Financial Arrangements
D80403 - Four (4) Problems Interjecting Medicare Between Kaiser and Patient
D80404 -
D80405 - Follow up ref SDS 8 T94H.
D80406 -
D80407 -    5.  Millie has four concerns in this matter centered on maintaining
D80408 -        care by Doctor Rugo going forward working with [the primary
D80409 -        care physician] at Kaiser, as listed in the record of our
D80410 -        meeting in your office on 070830. ref SDS 8 T94H, ref DIT 1
D80411 -        IL9L
D80412 -
D80413 -            [On 070925 telecon call with Bob seemed to indicate UCSF is
D80414 -            aware of Millie's 4 concerns listed on 070830 about
D80415 -            protecting legal rights that conflict with conisurance.
D80416 -            ref SDS 15 VE4N
D80418 -             ..
D80419 -            [On 071030 notify Kaiser of objective to develop
D80420 -            financial arrangemetns for continuing treatment at
D80421 -            UCSF. ref SDS 20 UB5S
D80423 -             ..
D80424 -            [On 071128 Kaiser Appeals Committee approved payment
D80425 -            for Millie's care on referral to UCSF. ref SDS 21 JZ5R
D80427 -         ..
D80428 -    6.  How Kaiser and UCSF work out payment is of no concern to
D80429 -        Millie.  She makes 2 insurance payments every month.  Kaiser
D80430 -        told her their coverage supplements Medicare.  This is
D80431 -        supported by research on 070917 showing Kaiser tells new
D80432 -        members they can cancel their Medigap coverage because Kaiser
D80433 -        takes care of it. ref SDS 12 EZ56, ref DIT 1 IL4J
D80434 -
D80435 -            [On 070927 Kaiser documentation saying on page 4 that
D80436 -            Senior Advantage is not supplemental, "Medigap," coverage,
D80437 -            ref SDS 16 1F6L; conflicts with Kaiser representations that
D80438 -            customers can cancel Medigap after signing up for Kaiser
D80439 -            Senior Advantage, reported on 070917, ref SDS 12 EZ56, and
D80440 -            further conflicts with Kaiser representations to Millie
D80441 -            that Senior Advantage supplements Medicare, that she did
D80442 -            not need additional insurance to maintain continuity of
D80443 -            treatment for cancer begun in 2002. ref SDS 16 4A9J
D80445 -         ..
D80446 -    7.  As you know, secondary coverage is responsible to pay for
D80447 -        coinsurance.  Accordingly, there is no reason for Millie to
D80448 -        receive 30 invoices a month with detail that would overwhelm
D80449 -        even Allen Greenspan, as shown in the record on 070830.
D80450 -        ref SDS 8 4P8K, ref DIT 1 IL4T
D80451 -
D80452 -
D80453 -
D805 -

SUBJECTS
Chemotherapy Drug Costs Paid by Clinical Trial Blood Test Laboratory

EZ03 -
EZ0401 -         ..
EZ0402 -        Charges Blood Tests Chemotherapy
EZ0403 -
EZ0405 -         ..
EZ0406 -    8.  Millie wondered why for example UCSF invoices show charges for
EZ0407 -        chemotherapy and related expenses when these costs are paid by
EZ0408 -        the clinical trial? [listed on 070830. ref SDS 8 NS4U],
EZ0409 -        ref DIT 1 IL5S
EZ0410 -
EZ0411 -            [On 070925 telecon with Bob disclosed that UCSF is
EZ0412 -            reviewing this issue to reduce confusion. ref SDS 15 VN5M
EZ0414 -             ..
EZ0415 -            [On 071009 USACE representative claims to have received
EZ0416 -            notice from unnamed people at Kaiser that the patient was
EZ0417 -            told the patient would be responsible for coinsurance in
EZ0418 -            Kaiser's transaction arranging for treatment on referral at
EZ0419 -            UCSF. ref SDS 18 N88P
EZ0421 -             ..
EZ0422 -            [On 071128 Kaiser Appeals Committee approved payment for
EZ0423 -            Millie's care on referral to UCSF. ref SDS 21 JZ5R
EZ0424 -
EZ0425 -
EZ0426 -
EZ05 -

SUBJECTS
Compromise Solution Payment Dispute Clinical Trial Coinsurance Stand

H003 -
H00401 -  ..
H00402 - Compromise Solution Standard Copayments Clinical Trial Treatments
H00403 -
H00404 -
H00405 -    9.  At this time, UCSF has billed Mil for about $1,500, as shown in
H00406 -        the record on 070917 reviewing your letter on 070912.
H00407 -        ref SDS 12 J14R, ref DIT 1 IL6N
H00409 -         ..
H00410 -   10.  I think Millie pays $30 or so for visiting the doctor at
H00411 -        Kaiser, $20 for blood tests, and nothing for treatment in the
H00412 -        infusion clinic.  She had 2 meetings a month at UCSF with the
H00413 -        medical team for 8 months, which makes 16.  $30 x 16 = $480.
H00414 -        Even though they told her at UCSF that doctor visits are paid
H00415 -        by the clinical trial, to compromise she is willing to pay this
H00416 -        amount, what ever the actual number is (your invoices vary from
H00417 -        $22 - $27).  Same for blood tests. $20 x 8 is $160.  That makes
H00418 -        a total of $640.  Millie paid $312 on 070906, so it seems she
H00419 -        owes $328.  Please explain what is being paid by the
H00420 -        approximate additional $900 UCSF seeks in its revised claim on
H00421 -        070912? ref DIT 1 IL6U
H00423 -         ..
H00424 -   11.  Thanks very much for professional, courteous work on a complex
H00425 -        issue. ref DIT 1 QF6J
H00426 -
H00427 -
H00428 -
H00429 -
H00430 -
H00431 -
H00432 -
H00433 -
H00434 -
H005 -