CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 23 0000. ref SDS 22 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060509 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - On 071010 Millie received a letter dated 071006 from Paula notifying
060902 - that Kaiser has initiated internal administrative review by an MCRC
060903 - Appeals Committee of Kaiser's failure to pay for prescribed treatment.
060904 - ref SDS 23 TH8L  Paula advised in her letter on 071006 that the
060905 - Appeals Committee will have a meeting on her case withing 60 days, and
060906 - that Millie make an appearance, and/or be represented to explain
060907 - patient history. ref SDS 23 813X
060909 -  ..
060910 - Millie has not actually filed an appeal. ref SDS 23 O94J  Issues are
060911 - listed on 071010 of legal support to either appear or consult on
060912 - preparing for meeting with Kaiser's MCRC Appeals Committee.
060913 - ref SDS 23 R16K
060915 -  ..
060916 - On 071012 research found an attorney who seemed somewhat familiar with
060917 - HMO Medicare insurance law, and indicated williness to consult via
060918 - email. ref SDS 24 UT4I  On 071015 a public agency litigation support
060919 - group for seniors offered assistance, but only after a hearing, and
060920 - Kaiser denies payment. ref SDS 25 IJ7F  On 071022 Millie asked about
060921 - help at N&P. ref SDS 26 3P4G  N&P indicated consideration would be
060922 - investigated. ref SDS 26 V63J  Yesterday, Millie sent follow up to
060923 - N&P. ref SDS 27 HB8J  Have still not hear anything.
060925 -  ..
060926 - Several initial steps are needed...
060927 -
060928 -    1.  Submit notice of receiving MCRC letter and ask for basis of
060929 -        appeal action in light of Millie not having filed an appeal.
060930 -
060931 -    2.  Submit authorization for representation.
060933 -         ..
060934 -    3.  Ask for procedures.
060936 -  ..
060937 - Millie submitted ref DIT 1 0001 via US mail with authorization for
060938 - representation through 081231 attached. ref SDS 23 824S  This was
060939 - printed and mailed to Paula at Kaiser's Pleasanton office, as set out
060940 - in Paula's letter dated 071006, and received on 071010. ref SDS 23
060941 - 814V
060943 -             ..
060944 -            [On 071026 Millie sent email notifying Paula at Kaiser that
060945 -            she had mailed the letter, ref DIT 1 0001, dated 071025 and
060946 -            with personal contact identification redacted for
060947 -            confidentiality. ref SDS 28 WC4N
060949 -         ..
060950 -    1.  I have received [on 071010] your Kaiser MCRC letter dated
060951 -        October 6, 2007, which says in part...
060952 -
060953 -        ...your request for appeal received on October 1, 2007 for
060954 -        Health Plan coverage for services provided by the UCSF Medical
060955 -        Center from January 30, 2007 through June 21, 2007. ref SDS 23
060956 -        TH8L
060958 -         ..
060959 -    2.  Attached (under separate cover via US mail) is my signed
060960 -        authorization for Rod Welch to represent me, using the form,
060961 -        ref DRP 2 PQPS, attached to your letter on October 6th.
060962 -        ref SDS 23 076T  Rod can be reached at my number *********** -
060963 -        and by email (********************) with copies to me
060964 -        (**********************).
060966 -         ..
060967 -    3.  Please submit procedures for the Appeals Committee meeting,
060968 -        including authority and questions the Committee has been asked
060969 -        to address in this case; what about witnesses?
060970 -
060971 -           [On 071029 Paula reported they have lost the 2nd page of
060972 -           Millie's authorization; Paula requested that Millie fax the
060973 -           document to expedite Kaiser's review. ref SDS 29 GM7M
060975 -            ..
060976 -           [On 071029 fax number in Kaiser's letter on 071006 turned
060977 -           out to be incorrect, ref SDS 29 PQVU; called Kaiser and got
060978 -           another number to fax the page lost at Kaiser. ref SDS 29
060979 -           0O4O
060980 -
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060987 -
0610 -