CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 43 0000. ref SDS 41 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060508 -
060510 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Kaiser Used 071002 Letter to CMS to Construct Millie's Appeal
060902 -
060903 - Follow up ref SDS 43 GM7M.
060904 -
060905 - Called to Paula per planning yesterday. ref SDS 43 0O4O
060906 -             ..
060907 -        a.  Authorization for representation Millie's letter on 071025
060908 -            received. ref SDS 38 AM3K
060910 -  ..
060911 - Paula said she received the fax from Millie with authorizations for
060912 - representation, which evidently was lost in Kaiser's mail room,
060913 - reported by Paula, also, yesterday. ref SDS 43 GM7M
060915 -             ..
060916 -        b.  Appeals Committee meeting...
060917 -
060918 -            1)  Date of hearing.
060920 -  ..
060921 - Paula advised that she has not scheduled a hearing yet; she is working
060922 - on assembling patient history of billing data at UCSF.
060924 -                 ..
060925 -            2)  Issue to be decided, see background in Kaiser letter on
060926 -                071010. ref SDS 31 TH8L
060928 -  ..
060929 - Paula advised that Kaiser constructed an appeal on Millie's behalf
060930 - based on the letter dated 071002 sent to CMS, ref SDS 23 OY4Q, and
060931 - which CMS then printed and faxed to Kaiser along with 50 pages of
060932 - background cited in the letter, e.g., the case study on 070830.
060933 - ref SDS 15 LQ5I  On 071009 Jullin Kwok reported having printed 50
060934 - pages of the letter dated 071002 and sending to a research department,
060935 - ref SDS 28 EX5J, for guidance on question in the letter, ref SDS 23
060936 - OY4Q; Jullin did not mention sending the letter to Kaiser as well.
060937 - ref SDS 28 LT7J
060939 -  ..
060940 - Paula confirmed the date of 071001 in the first paragraph in Kaiser's
060941 - letter on 071006 was a mistake, and should have been 071002, as shown
060942 - on 071002. ref SDS 23 KA5J
060944 -  ..
060945 - She explained that Kaiser's letter to Millie on 071006 is a form
060946 - letter, and so omits presenting the actual record of CMS submitting a
060947 - letter to Kaiser, and this letter was originally sent to CMS on
060948 - 071002, ref SDS 23 KA5J, and instead incorrectly alleges Millie filed
060949 - an appeal by submitting documents to Kaiser.
060951 -                 ..
060952 -            3)  "Determination" being appealed, cited in review of
060953 -                letter on 071010? ref SDS 31 813X
060955 -  ..
060956 - Paula advised the Regional Appeals Committee has authority to order
060957 - appropriate Kaiser staff to recognize and process the doctor's
060958 - authorization for Millie's treatment at UCSF on referral in a clinical
060959 - trial, reported by the primary care physician on 070119, ref SDS 10
060960 - 4R4M, or otherwise to effect submission of authorization for UCSF to
060961 - treat Millie in a clinical trial and submit billings to Kaiser rather
060962 - than to the patient, as agreed on 061230, and justified by patient
060963 - history in this case.
060964 -
060965 -            [...below, Paula's plan for resolution of payment problem
060966 -            is for the doctor to prepare another authorization for
060967 -            Millie's treatment on referral, and for Kaiser to submit
060968 -            the doctor's authorization to UCSF. ref SDS 0 FN4N
060970 -             ..
060971 -            [On 071116 the primary care physician advised that another
060972 -            authorization for Millie's care on referral to UCSF was
060973 -            prepared. ref SDS 48 EN78
060975 -             ..
060976 -            [On 071128 Paula advised that the Kaiser Appeals Committee
060977 -            approved payment for Millie's care on referral to UCSF.
060978 -            ref SDS 50 JZ5R
060980 -  ..
060981 - Paula advised that the Kaiser's MCRC department will present to
060982 - Kaiser's internal Appeals Committee UCSF billings for Millie's
060983 - treatment which have been previously denied for payment by Kaiser.
060984 - Paula has obtained Kaiser's payment denial letters from Kaiser's
060985 - computer system.  She wants to verify accuracy of the data by
060986 - correlating Kaiser's records with Millie's documentation from UCSF.
060987 - Paula related having found on Kaiser's computer six (6) letters
060988 - denying payment of billings from UCSF for Millie's treatment.
060990 -  ..
060991 - During the call, review shows Millie has so far received 13 letters
060992 - from Kaiser refusing payment to UCSF, reported initially on 070823.
060993 - ref SDS 14 X16N  Paula then said she found another 5 payment denials
060994 - by "turning the page" on her computer screen.  This makes a total of
060995 - 11 payment denials compared to 13 Millie has actually received.  We
060996 - agreed there are likely more of these denials in the mail which have
060997 - not yet been received by Millie nor posted to Kaiser's computer.
060999 -  ..
061000 - Further review indicates there is minimal correlation between Kaiser
061001 - denials for payment, and UCSF entitlement to payment on billings for
061002 - Millie's medical treatment in the clinical trial.  Kaiser's records
061003 - conflict significantly with UCSF billings.
061005 -  ..
061006 - Of the 13 Kaiser denial letters, 7 or so are doctor payments that
061007 - correlate to pink invoices Millie received on 071006, and which had
061008 - not previously been sent to Millie. ref SDS 26 PRWW  UCSF has sent
061009 - more of these bills to Kaiser than have been submitted to Millie,
061010 - which may account for delays in Millie receiving notice of these
061011 - charges, cited on 071006, ref SDS 26 PRWW, and reported by Millie on
061012 - 071011. ref SDS 32 K64T
061014 -  ..
061015 - The other 5 denial letters Millie has received from Kaiser do not
061016 - cover all of the 22 or so billings UCSF seeks to recover from Millie
061017 - shown by UCSF's spreadsheet received with UCSF's letter dated 070912,
061018 - and received on 070917. ref SDS 19 WP5I  Most recently on 071026 UCSF
061019 - listed 8 charges, but it later turned out these billings only cover
061020 - "Facility Accounts," and only extend through 070802. ref SDS 39 SU4Q
061021 - UCSF has provided continuing weekly treatments to Millie for the past
061022 - 3 months, approximately 3 x 4 = 12 additional charges, which have not
061023 - been billed, and there is at least a 2nd set of billings with 10 - 15
061024 - charges for professional services, per above. ref SDS 0 FM8H
061026 -  ..
061027 - Thus, while Paula has found only 11 denial letters listed on Kaiser's
061028 - computer, there may be another 30 - 40 billings to be settled for
061029 - UCSF's work.  Millie has asked UCSF for a total all charges, and so
061030 - far UCSF has resisted providing clear and complete information on
061031 - billings, reported on 071029. ref SDS 43 6N6K
061032 -
061033 -            [On 071114 Paula reported delay getting information from
061034 -            UCSF to resolve conflicts in data found in Kaiser's
061035 -            computers. ref SDS 47 NE5P
061037 -             ..
061038 -            [On 071126 Paula requested support from SDS records to
061039 -            resolve problems getting information from Kaiser computers
061040 -            and from UCSF. ref SDS 49 H67R
061041 -
061043 -  ..
061044 - Kaiser Will Request Billing and Support Records from UCSF
061045 - UCSF Justify Claim for Payment Based on Record of Work Performed
061046 -
061047 - Paula decided Kaiser should contact UCSF and request all of their
061048 - billings rather than rely on Kaiser's denial letters for presentation
061049 - to the Appeals Committee.  Paula also needs UCSF records verifying
061050 - work performed in the billings, including notes prepared by the doctor
061051 - reporting meetings with the patient for examinations, diagnosis,
061052 - prescriptions, assessment of prognosis, and she needs Nurses Notes
061053 - describing daily treatments in the Infusion Clinic.
061054 -
061055 -            [...below, letter to UCSF reports Kaiser will request
061056 -            billing and support records. ref SDS 0 JA4S
061058 -             ..
061059 -            [...below, Millie received letter from UCSF reporting Paula
061060 -            called and requested billing information, and so Millie
061061 -            should ignore UCSF prior demands for immediate payment.
061062 -            ref SDS 0 WZ5J
061064 -             ..
061065 -            [On 071031 Millie receives notice dated 071026 UCSF has
061066 -            scheduled assignment to a collection agency for payment of
061067 -            account 12493370 in the amount of $202.65, ref SDS 45 KK4I,
061068 -            reviewed on 070830, ref SDS 15 4P8K, and revised again on
061069 -            070917, ref SDS 19 MK4H; there is no indication of UCSF
061070 -            collection efforts against Kaiser who ordered the work; and
061071 -            in a separate notice the next day on 071027 UCSF threatens
061072 -            that Millie's treatment for cancer ordered on referral by
061073 -            Kaiser will be terminated if UCSF does not receive payment
061074 -            from Millie, which is owed by Kaiser. ref SDS 45 KM8J
061076 -  ..
061077 - Paula was already familiar with UCSF practices of billing separately
061078 - for facility accounts (white invoices sent to Millie beginning in
061079 - August), and for doctor services (pink invoices sent to Millie on
061080 - 071006).  Paula will ask UCSF for a full accounting of all charges,
061081 - which Millie requested on 071010. ref SDS 30 HZ6P  Later on 071010
061082 - UCSF responded that additional charges are being prepared, and UCSF
061083 - would assemble these added amounts and submit to Millie. ref SDS 30
061084 - OH89
061086 -  ..
061087 - On 071024 Millie asked UCSF again for a full accounting of charges,
061088 - and noted that whether the patient or Kaiser pays, UCSF will have
061089 - present its complete claim and justification. ref SDS 36 EP9V
061090 -
061091 -
061093 -  ..
061094 - Appeals Hearing Procedures Misrepresented by Kaiser Form Letter
061095 - Kaiser's Letter on Notice of Hearing Misrepresented Customer Rights
061096 -
061097 -
061098 -            4)  Procedures for hearing listed on 071010. ref SDS 31
061099 -                4V7H
061101 -  ..
061102 - Paula advised today that the explanation in Kaiser's letter dated
061103 - 071006 and received on 071010 that Millie and her representative can
061104 - appear before the Appeals Committee is incorrect. ref SDS 31 R16K
061106 -  ..
061107 - She explained today that her letter dated 071006 is a Kaiser standard
061108 - form prepared by company lawyers which she, as the claims's analyst
061109 - and person dealing with the customer, is no authorized to change.
061110 - Paula explained today that in fact the only way an appellant can
061111 - "appear" before the Appeals Commitees is through a 10 minute telephone
061112 - conference, and that the Appeals Committee rarely does this, and
061113 - perfers to work entirely from information assembled by Kaiser's staff,
061114 - in this case Paula.
061116 -  ..
061117 - Discussed challenge for Appeals Committee to understand relevant facts
061118 - from complex patient history, noted by Jullin Kwok, reported on
061119 - 071003, ref SDS 24 BZ40, in a 10 minute telephone call, and in
061120 - relation to 16 issues listed on 070927. ref SDS 22 8G5N  On 071006
061121 - Paula, who has responsiblity to prepare this case for the Appeals
061122 - Committee reported she was overwhelmed from the small part of the
061123 - record which she received ad hoc from Jullin Kwok. ref SDS 26 9P5J
061125 -  ..
061126 - Paula apologized for misunderstandings about hearing procedures.  She
061127 - plans to work very hard to understand everything from Kaiser's
061128 - computer, and will coordinate to get all the relevant data from UCSF's
061129 - computers.   She expects a hearing in a few weeks, and will notify
061130 - Millie of the results.
061132 -  ..
061133 - Requested written procedures for Appeals Committee hearings and
061134 - adjudication.  Paula will look for this and submit.
061135 -
061136 -                [On 071105 Paula advised that Kaiser does not provide
061137 -                written procedures to customers who have hearings
061138 -                before the Appeals Committee. ref SDS 46 K43W
061140 -             ..
061141 -        c.  Case Review Patient History
061142 -
061143 -            Kaiser ordered Millie's clinical trial on referral to UCSF
061144 -            continue discussion begun with Paula's call on 071006.
061145 -            ref SDS 26 KA5J
061147 -  ..
061148 - Paula seemed familiar with the case from having reviewed the record on
061149 - 070830 meeting with UCSF, as planned on 071006. ref SDS 26 TM94
061151 -  ..
061152 - Paula has learned through investigation and discussion with the
061153 - primary care physician that Kaiser ordered treatment for Millie on
061154 - referral to UCSF, as reported previously to UCSF on 070830.
061155 - ref SDS 15 T247, citing correspondence between Kaiser and UCSF on
061156 - 061230, ref SDS 7 3X6K, and the record on 070105. ref SDS 8 PK68  This
061157 - was confirmed by the primary care physician on 070119, ref SDS 10 4R4M
061158 - Doctor Rugo reported Kaiser made the referral in a letter on 070906.
061159 - ref SDS 17 UK5M
061161 -  ..
061162 - Paula asked how long Millie's treatment in the clinical trial will
061163 - continue, and goals for resolving the current dispute?
061165 -  ..
061166 - We reviewed the clinical trial protocol documents received from UCSF
061167 - on 070116, which show that treatments continue until progression of
061168 - disease. ref SDS 9 FC5M  The meeting at UCSF on 070830 presented goals
061169 - to establish terms and conditions for Millie's treatment in the
061170 - current study, and for further treatments at UCSF. ref SDS 15 T94H
061171 - This was reviewed again with UCSF on 070924, ref SDS 21 UL5R
061172 - Objectives for dispute resolution were discussed with Paula when she
061173 - called on 071006. ref SDS 26 Q963
061175 -  ..
061176 - On 071006 Paula planned to investigate what happened to the doctor's
061177 - referral, resulting in Kaiser denying payment to UCSF for lack of
061178 - doctor's authorization. ref SDS 26 TM77
061180 -  ..
061181 - Paula has not been able to find what happened to the referral
061182 - authorization that was submitted on 070119, ref SDS 10 LW9N, and noted
061183 - by the primary care physician as "missing in action," in a letter on
061184 - 070907. ref SDS 18 XH5H  It just disappeared, confirmed in a call with
061185 - Kaiser Senior Advantage Member Services on 070917. ref SDS 19 E14R
061187 -  ..
061188 - Paula proposes solving this case by...
061189 -
061190 -        1.  Kaiser pay UCSF for outstanding amounts on account.
061191 -
061192 -        2.  Primary care physician prepare another referral order, and
061193 -            Kaiser will send it to UCSF for billing continuing
061194 -            treatments on the clinical trial.
061195 -
061196 -               [On 071116 primary care physician reports re-submitting
061197 -               authorization for Millie's treatment on referral at
061198 -               UCSF, ref SDS 48 BO6L; indicates Kaiser's accepts
061199 -               responsibility for Medigap coverage. ref SDS 48 EN78
061201 -                ..
061202 -               [On 071128 Paula advised that the Kaiser Appeals
061203 -               Committee approved payment for Millie's care on referral
061204 -               to UCSF. ref SDS 50 JZ5R
061206 -  ..
061207 - Submitted letter to UCSF notifying of progress toward Kaiser Regional
061208 - Appeals Committee process....
061209 -
061210 -    1.  Subject: Payment Resolution Progress
061211 -        Date: Tue, 30 Oct 2007 17:09:31 -0700
061212 -        From:  Rod Welch
061223 -         ..
061224 -    3.  Following up the letter to UCSF yesterday on 071029, shown
061225 -        below,  we are now discussing with Paula McPhail in Kaiser's
061226 -        MCRC unit resolution of payment dispute between UCSF and
061227 -        Kaiser.
061229 -         ..
061230 -    4.  Paula advised this morning that she has confirmed Kaiser made
061231 -        the referral for Millie's care at UCSF. ref SDS 0 FM6H  She
061232 -        proposes settling past accounts, and the doctor will issue the
061233 -        referral again, ref SDS 0 FN4N with the original date OA
061234 -        070119, ref SDS 10 4R4M, since Paula's investigations have been
061235 -        unable to find what happened to the referral submitted at that
061236 -        time. ref SDS 0 FM67
061238 -         ..
061239 -    5.  The doctor's referral will permit UCSF to regularize billings
061240 -        and payments on this account, as originally planned.
061241 -
061242 -            [On 071031 Millie receives notice dated 071026 UCSF has
061243 -            scheduled assignment to a collection agency for payment of
061244 -            account 12493370 in the amount of $202.65, ref SDS 45 KK4I,
061245 -            reviewed on 070830, ref SDS 15 4P8K, and revised again on
061246 -            070917, ref SDS 19 MK4H; there is no indication of UCSF
061247 -            collection efforts against Kaiser who ordered the work; and
061248 -            in a separate notice the next day on 071027 UCSF threatens
061249 -            that Millie's treatment for cancer ordered on referral by
061250 -            Kaiser will be terminated if UCSF does not receive payment
061251 -            from Millie, which is owed by Kaiser. ref SDS 45 KM8J
061253 -         ..
061254 -    6.  Paula plans to call UCSF (gave her Bob's number) and ask for an
061255 -        accounting of UCSF's claim for outstanding expenses owed by
061256 -        Kaiser. ref SDS 0 FM95  She will incorporate UCSF's work
061257 -        product into a presentation for the MCRC Appeals Committee.
061258 -        She needs UCSF records showing work performed in Doctor's Notes
061259 -        and Nurse's Notes in Millie's Medical Chart at UCSF that
061260 -        support UCSF billings.
061261 -
061262 -           [...below, UCSF reports receiving notice from Kaiser on
061263 -           processing payments. ref SDS 0 WZ5J
061265 -            ..
061266 -           [On 071031 Paula called and requested assistance getting
061267 -           documentation from UCSF to expedite payment for Millie's
061268 -           treatment. ref SDS 44 NT3J
061270 -            ..
061271 -           [On 071105 letter to UCSF and Kaiser confirms Paula still
061272 -           needs doctor's notes, and that Kaiser does not need Nurses
061273 -           Notes for work in the Infusion Clinic afterall. ref SDS 46
061274 -           K37Q
061276 -            ..
061277 -           [On 071116 primary care physician reports authorization
061278 -           re-submitted for Millie's treatment on referral at UCSF
061279 -           beginning on 070119, ref SDS 48 BO6L; indicates Kaiser's
061280 -           accepts responsibility for Medigap coverage. ref SDS 48 EN78
061282 -            ..
061283 -           [On 071116 Paula reports Kaiser has not received documents
061284 -           requested from UCSF. ref SDS 48 ET8H
061286 -            ..
061287 -           [On 071128 Kaiser Appeals Committee approved payment for
061288 -           Millie's care on referral to UCSF. ref SDS 50 JZ5R
061290 -         ..
061291 -    7.  In the interests of transparency, Millie would like to receive
061292 -        prior to Appeals Committee review the information given to the
061293 -        Committee.  Paula clarified during the call today the
061294 -        representation in Kaiser's letter dated 071006 that Millie can
061295 -        appear at the Committee meeting. ref SDS 31 R16K
061297 -         ..
061298 -    8.  She seemed to indicate the only way for an appellant to assist
061299 -        the Committee is with a 10 minute telephone call. ref SDS 0
061300 -        FM66  Complexity of patient history was noted on 071003 by
061301 -        Jullin Kwok, CMS contract manager for Kaiser's Medicare unit,
061302 -        ref SDS 24 BZ40, citing multi-agency involvement and 16 issues
061303 -        of regulation, medical practice, and contract interpretation.
061304 -        [listed on 070927] ref SDS 22 8G5N
061306 -         ..
061307 -    9.  Paula will review requirements for briefing the Appeals
061308 -        Committee in the context of Millie's complex patient history.
061310 -         ..
061311 -   10.  Millie appreciates everyone's assistance providing data Paula
061312 -        needs to expedite payment for UCSF.  Millie regrets delays, and
061313 -        further notes Paula's caution on 071006 that mere presentation
061314 -        of UCSF's claim does not guarantee resolution at this level by
061315 -        Kaiser. ref SDS 26 TL98
061317 -         ..
061318 -   11.  Never-the-less, Kaiser deserves UCSF's support working through
061319 -        this important step in the claims recovery process.
061320 -
061321 -           [On 071031 Paula called and requested assistance getting
061322 -           documentation from UCSF to expedite payment for Millie's
061323 -           treatment. ref SDS 44 NT3J
061325 -            ..
061326 -           [On 071105 letter to UCSF and Kaiser confirms Paula still
061327 -           needs doctor's notes, and that Kaiser does not need Nurses
061328 -           Notes for work in the Infusion Clinic afterall. ref SDS 46
061329 -           K37Q
061331 -            ..
061332 -           [On 071116 primary care physician reports authorization
061333 -           re-submitted for Millie's treatment on referral at UCSF
061334 -           beginning on 070119, ref SDS 48 BO6L; indicates Kaiser's
061335 -           accepts responsibility for Medigap coverage. ref SDS 48 EN78
061337 -            ..
061338 -           [On 071116 Paula reports Kaiser has not received documents
061339 -           requested from UCSF. ref SDS 48 ET8H
061341 -            ..
061342 -           [On 071126 UCSF has not submitted documents to Kaiser that
061343 -           substantiate charges for Millie's care. ref SDS 49 TH8L
061345 -            ..
061346 -           [On 071128 Kaiser Appeals Committee approved payment for
061347 -           Millie's care on referral to UCSF. ref SDS 50 JZ5R
061348 -
061349 -
061351 -  ..
0614 -
0615 -
0616 - 1822
0617 -
061701 - UCSF Says Disregard Demand for Payment in 1 Week Pending Kaiser Review
061702 -
061703 - Follow up ref SDS 39 SU5V.
061704 -
061705 - Millie received a letter from UCSF following up the letter on 071029,
061706 - ref SDS 43 KS4U, and saying...
061707 -
061708 -    1.  Subject:  Demand for Payment 1 Week
061709 -        Date: Tue, 30 Oct 2007 16:16:35 -0700
061719 -
061720 -        I just received a call from Paula (at Kaiser) regarding
061721 -        Kaiser's review of your UCSF billing records.  Please disregard
061722 -        my request for payment on the eight UCSF facility accounts
061723 -        until Kaiser has determined if you have any financial
061724 -        responsibilty for these services.
061726 -  ..
061727 - This letter shows Paula followed up on planning earlier today for
061728 - Kaiser to contact UCSF about gettting information to pay for Millie's
061729 - care on referral. ref SDS 0 FM95
061730 -
061731 -            [On 071031 Millie receives notice dated 071026 UCSF has
061732 -            scheduled assignment to a collection agency for payment of
061733 -            account 12493370 in the amount of $202.65, ref SDS 45 KK4I,
061734 -            reviewed on 070830, ref SDS 15 4P8K, and revised again on
061735 -            070917, ref SDS 19 MK4H; there is no indication of UCSF
061736 -            collection efforts against Kaiser who ordered the work; and
061737 -            in a separate notice the next day on 071027 UCSF threatens
061738 -            that Millie's treatment for cancer ordered on referral by
061739 -            Kaiser will be terminated if UCSF does not receive payment
061740 -            from Millie, which is owed by Kaiser. ref SDS 45 KM8J
061742 -             ..
061743 -            [On 071128 Kaiser Appeals Committee approved payment for
061744 -            Millie's care on referral to UCSF. ref SDS 50 JZ5R
061745 -
061747 -         ..
061748 -    3.  Wishing you the best,
061749 -
061772 -
061773 -
061775 -  ..
0618 -
0619 -
0620 - 2150
0621 -
062101 - Millie submitted a letter to UCSF Accounting Department explaining...
062102 -
062103 -    1.  Subject: Payments Buck Account
062104 -        Date: Tue, 30 Oct 2007 21:59:56 -0800
062111 -         ..
062112 -    3.  I am delighted about progress at Kaiser toward payment of
062113 -        referral services reported in Rod's letter earlier today to you
062114 -        and others in my extended medical team. ref SDS 0 FN7H
062142 -         ..
062143 -    6.  On October 9th I received a call from "Kitty" at Kaiser.  She
062144 -        would not talk to Rod, and insisted she could only talk to me
062145 -        because HIPAA rules prevent giving out sensitive medical
062146 -        information to anyone but the patient.  Eventually, I took the
062147 -        call.  This woman said that Mr.  Schwartz had called her and
062148 -        asked that she call me to complain about UCSF getting letters
062149 -        showing efforts to have Kaiser pay UCSF what is owed for
062150 -        referral services. ref SDS 29 JW7M  Naturally, I didn't believe
062151 -        that UCSF would complain to Kaiser about being in the loop on
062152 -        efforts to get Kaiser to pay up.
062154 -         ..
062155 -    7.  However, shortly after getting this call, I got a letter from
062156 -        Mr. Schwartz.  As you can see, he confirmed having called
062157 -        Kitty and asking her to call me and say that I should not ask
062158 -        you folks to explain your bills, but should ask Kaiser to
062159 -        explain UCSF invoices. ref SDS 29 X65I
062161 -         ..
062162 -    8.  I realize that billings present complex, difficult choices.  I
062163 -        appreciate very much that you have an important job.  I do not
062164 -        begrudge Bob carrying out instructions to be a tough bill
062165 -        collector.  I feel however that people can be tough and also be
062166 -        constructive, and this applies to both sides of the
062167 -        transaction.
062169 -         ..
062170 -    9.  Hopefully, Kaiser will step up to align its position with legal
062171 -        and contractual requirements.  In that case, UCSF will benefit
062172 -        both from timely payment and having an experienced partner who
062173 -        does not have to be educated about medical billings, which
062174 -        presents a significant legal issue, reviewed on 070927.
062175 -        ref SDS 22 T78J  If Kaiser continues to resist, I am hopeful we
062176 -        can work together to implement the agreement that UCSF and
062177 -        Kaiser made on 061230 for Kaiser to pay any costs not covered
062178 -        by the clinical trial. ref SDS 7 3X6K  [and noted by Paula's
062179 -        research reported today, per above. ref SDS 0 JA9U]
062181 -         ..
062182 -   10.  Someday, you may be in an examination room with a doctor.  You
062183 -        may be frightened and uncertain about the future.  You may not
062184 -        be feeling well.  You will depend on your doctor to prescribe
062185 -        treatment that you need and when he says all the costs will be
062186 -        paid you will have no reason to doubt his word, because you
062187 -        will have had six years of experience when the doctor said the
062188 -        same thing, and always made good on his word, and you have a
062189 -        million other things racing through your mind besides language
062190 -        buried on page 68 of a thick insurance manual that you never
062191 -        read, because the doctor is your coordinator who takes care of
062192 -        all that. [see EOC Section 2 reviewed on 070927, ref SDS 22
062193 -        WS6M]
062195 -         ..
062196 -   11.  Bob said in a telephone call the other day I should just pay
062197 -        up, because the amount involved today is fairly nominal,
062198 -        something like $500, $1,000, $2,000.  I could do that and make
062199 -        this go away.  I could say, OK, I was duped; taken in; I guess
062200 -        I can't trust the doctor after all.  I believe that reliance on
062201 -        the doctor is a core principle of care that deserves support.
062203 -         ..
062204 -   12.  I happen to like my doctor.  He, along with Doctor Rugo this
062205 -        past year, has saved my life, and made my life worth living
062206 -        again.  I feel he should be supported to continue his work for
062207 -        me and others, so that when the doctor orders treatment, other
062208 -        folks who know nothing of patient history do not arbitrarily
062209 -        pull the rug out from under him and his patients with fancy
062210 -        financial engineering hoping to transfer all costs of care to
062211 -        others.
062213 -         ..
062214 -   13.  I hope that UCSF agrees going forward.
062215 -
062216 -
062217 -
062218 -
062219 -
062220 -
062221 -
062222 -
0623 -