CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 0000, ref SDS 7 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday afternoon, Millie received a letter from Doctor Johnson
040902 - advising that instead of filing a referral for Millie's treatment to
040903 - recover from the 8th relapse of cancer, and further instead of filing
040904 - an apeal with Member Services of Doctor Mason's verbal refusal to
040905 - authorize the doctor's referral for Millie's treatment, Doctor Johnson
040906 - sent all correspondence on this matter to Doctor Mason, including the
040907 - draft appeal, which Doctor Johnson had requested from the patient for
040908 - him to file with Member Services, reported on 090519 1536, ref SDS 5
040909 - 5K7H
040911 -  ..
040912 - The doctor cited ignorance of government regulations for failure to
040913 - prescribe urgently needed treatment for Millie to recover from 8th
040914 - relapse of cancer, reported on 090519 1536, ref SDS 5 VK9H
040916 -  ..
040917 - Yesterday afternoon, Millie sent a response to Doctor Johnson's
040918 - letter, and asking Kaiser to prescribe treatment for her 8th relapse
040919 - of cancer as called out by Kaiser's standard of care for oncology.
040920 - 090519 1613. ref SDS 6 TY3X   Millie asked the doctor to call about
040921 - scheduling treatment. ref SDS 6 TY4W
040923 -  ..
040924 - On 090520 1053, since the doctor has not called, this morning, called
040925 - and left a message for Doctor Johnson to discuss when Millie needs to
040926 - start treatment in order for care to be effective recovering from the
040927 - 8th relapse of cancer. ref SDS 8 IW6O  Need to know how much time can
040928 - be invested to assist Kaiser with regulatory issues, as noted in the
040929 - letter yesterday, reported on, 090519 1613, ref SDS 6 TX4W
040931 -  ..
040932 - On 090520 1113 Millie received a letter from Doctor Johnson failing to
040933 - prescribe treatment, and saying Kaiser "offers" Millie Gemzar or
040934 - Navelbine, and further confirmed these treatments are high risk of
040935 - failure and causing harm for Millie's patient profile, and said Member
040936 - Services and Outside Referrals interpret clinical trials for Millie to
040937 - recover from 8th relapse of cancer. ref SDS 9 UC9G
040939 -  ..
040940 - Today, on 090520 1137 Millie responded to Doctor Johnson with copies
040941 - to the medical team, including Paula, who was helpful resolving prior
040942 - communication problems with Kaiser, and Millie explained urgency for
040943 - Kaiser to prescribe treatment appropriate to Millie's patient profile,
040944 - and in time to be effective, ref SDS 10 5K9M, and noted requests for
040945 - Doctor Johnson to call and expedite care, and several unreturned calls
040946 - to the doctor. ref SDS 10 SR6R   Millie further requested medical
040947 - advice on trade-offs between treatment options, and on how soon
040948 - treatment must be started in order to have a chance of being
040949 - effective. ref SDS 10 SS3W
040950 -
040951 -
040952 -
040954 -  ..
0410 -
0411 -
0412 - Discussion
0413 -
041301 - Evidences-based Medical Practice Kaiser Policy Requires
041302 - Kaiser Policy Requires Evidences-based Medical Practice
041303 -
041304 - Paula had received Millie's letter sent to the medical team this
041305 - morning at 1149, which relates patient history, reported on, 090520
041306 - 1137, ref SDS 10 5K9M
041308 -  ..
041309 - Paula had also received Millie's letter on 090515 notifying the
041310 - medical team that Millie holds Kaiser liable for the cost of her care.
041311 - reported on 090515 1017, ref SDS 4 6Q4Y
041313 -  ..
041314 - Paula advised that Kaiser's policy requires "evidenced-based" medical
041315 - practice for patient care.  She explained that Millie's doctor must
041316 - base treatment on the best evidence that optimizes recovery, and
041317 - reduces suffering, and cost.
041318 -
041319 -        [On 090725 2017 research found book, "Understanding Evidenced
041320 -        Based Medicine," that explains requirements for doctors at
041321 -        Kaiser to use evidenced based medical practice. ref SDS 14
041322 -        T55W; additional published opinion on standard of care for
041323 -        evidenced based medicine requires doctors to present trade-offs
041324 -        to patients on treatments for effectiveness, side effects, and
041325 -        cost. ref SDS 14 T58U
041327 -  ..
041328 - Paula suggested calling Expedited Claims Department in Oakland,
041329 - because Millie needs urgent treatment.  Paula explained that after
041330 - Expedited Claims rules on Millie's case, Paula's office in Member
041331 - Services will be notified and can take action, if Expedited Claims
041332 - does not resolve the problem to the satisfaction of the customer.
041334 -  ..
041335 - Paula found the number for Expedited Claims from the work we did on
041336 - 081112 getting started on the sunitinib clinical trial. ref SDS 2 PQ35
041337 -
041338 -                         888 987 7247
041339 -
041340 -        [On 090520 1203 called Kaiser Expedited Claims in Oakland,
041341 -        ref SDS 11 4M9G, and talked to Pamela Powell, ref SDS 11 PQ8P,
041342 -        and presented Millie's claim to get treatment based on best
041343 -        evidence for standard of care in time to be effective
041344 -        recovering from 8th relapse of cancer. ref SDS 11 9595
041346 -         ..
041347 -        [On 090521 0902 Pamela called back and said Expedited Claims
041348 -        cannot rule on Millie's request for support, because Millie's
041349 -        case falls through the cracks; Expedited claims cannot deny
041350 -        Millie's request for the doctor to prescribe treatment, but do
041351 -        not want to issue an order for a Kaiser doctor to prescribe
041352 -        care for a patient, and so Expedited Claims called Doctor
041353 -        Johnson to encourage resolution, and also submitted the case to
041354 -        Member Services in Pleasenton. ref SDS 12 UD5H
041356 -         ..
041357 -        [On 090521 2006 Millie received a letter from Doctor Johnson
041358 -        that confirms Kaiser refuses to prescribe treatment, saying
041359 -        instead that Millie can "choose" the next treatment, because no
041360 -        treatment is superior to another for Millie's patient profile,
041361 -        ref SDS 13 UD5H; the doctor says Millie needs urgent treatment
041362 -        and so should notify Kaiser which treatment Millie chooses by
041363 -        the end of the week, which is the next day in roughly 12 hours.
041364 -        ref SDS 13 HC8O; the doctor further tells Millie to call
041365 -        Medicare for prescribing appropriate treatment. ref SDS 13 HC93
041367 -  ..
041368 - At that time Michelle in the Expedited Claims Department gave
041369 - important guidance that Kaiser must implement the doctor's order for
041370 - patient care. ref SDS 2 PR35
041372 -  ..
041373 - Thanked Paula for help.
041374 -
041375 -        [On 090520 1203 called Kaiser Expedited Claims in Oakland,
041376 -        ref SDS 11 4M9G, and talked to Pamela Powell, ref SDS 11 PQ8P,
041377 -        and presented Millie's claim to get treatment for standard of
041378 -        care in time to be effective recovering from her 8th relapse of
041379 -        cancer. ref SDS 11 9595
041381 -         ..
041382 -        [On 090521 2006 Millie received a letter from Doctor Johnson
041383 -        that confirms Kaiser refuses to prescribe treatment, saying
041384 -        instead that Millie can "choose" the next treatment, because no
041385 -        treatment is superior to another for Millie's patient profile,
041386 -        ref SDS 13 UD5H; the doctor says Millie needs urgent treatment
041387 -        and so should notify Kaiser which treatment Millie chooses by
041388 -        the end of the week, which is the next day in roughly 12 hours.
041389 -        ref SDS 13 HC8O; the doctor further tells Millie to call
041390 -        Medicare for prescribing appropriate treatment. ref SDS 13 HC93
041392 -         ..
041393 -        [On 090521 0902 Pamela called back and said Expedited Claims
041394 -        cannot rule on Millie's request for support, because Millie's
041395 -        case falls through the cracks; Expedited claims cannot deny
041396 -        Millie's request for the doctor to prescribe treatment, but do
041397 -        not want to issue an order for a Kaiser doctor to prescribe
041398 -        care for a patient, and so Expedited Claims called Doctor
041399 -        Johnson to encourage resolution, and also submitted the case to
041400 -        Member Services in Pleasenton. ref SDS 12 UD5H
041401 -
041402 -
041403 -
041404 -
041405 -
041406 -
041407 -
0415 -