CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 17 0000. ref SDS 16 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Letter to Robin saying...
040902 -
040903 - 1. Subject: Recover Complicatiions Knee Surgery
040904 - Date: Sat, 23 Jun 2012 04:58:05 -0700
040911 - ..
040912 - 2. As we have discussed on May 28, you may have serious
040913 - complications from knee surgery [...reported on 120528 0913.
040914 - ref SDS 11 SV7M; despite diagnosis by knee surgeon, Doctor
040915 - Lawler, that Robin had to endure continuing pain to recover
040916 - from knee surgery on 120322, reported on 120601 2232,
040917 - ref SDS 13 YQ8Y...], with pain the length of your leg over 3
040918 - months post proc, reported in your recent letter on June 19th.
040919 - ...[reported on 120619 2226. ref SDS 17 V48V...]
040920 -
040921 - [On 120629 1019 another letter to Robin on visiting to
040922 - attend wine tasting event with Bob and his brother Allen.
040923 - ref SDS 19 Q45H
040925 - ..
040926 - [On 120629 1019 at 2226 letter from Robin reports getting
040927 - treatment for her knee with physical therapy. ref SDS 19
040928 - LK7H
040930 - ..
040931 - [On 120718 1842 Robin reports knee pain worsened; she
040932 - ordered MRI radiology scan on 120717; results show 2
040933 - new tears since surgery on 120322, explaining
040934 - continuing pain from complications after knee surgery;
040935 - Robin planning 2nd opinions, and meeting with original
040936 - surgeon on 120730. ref SDS 20 N48J
040938 - ..
040939 - 3. You need the medical chart for the procedure on March 22, and all
040940 - examinations post procedure. We need to know precisely what the
040941 - doctor and others have reported.
040943 - ..
040944 - 4. Now that you have a quasi-2nd opinion from a chiropractor, [...
040945 - cited in Robin's letter on 120619 2226. ref SDS 17 V48V...]
040946 - recommend writing a letter to Lawler with copy to your
040947 - insurance company saying something like...
040948 -
040949 - ******************
040951 - ..
040952 - 1. Dear Doctor Lawler,
040954 - ..
040955 - 2. This confirms telecon with your office that you have
040956 - prescribed physical therapy to treat continuing severe pain
040957 - from complications following knee surgery performed a few
040958 - months ago on March 22. Prescription for physical therapy
040959 - supplements planning in our meeting on May 31st, when you
040960 - indicated pre-existing arthritis delays my recovery from
040961 - knee surgery, and that you gave cortisone injections to
040962 - speed my recovery.
040963 -
040964 - [On 120718 1842 Robin reports knee pain worsened; she
040965 - ordered MRI radiology scan on 120717; results show 2
040966 - new tears since surgery on 120322, explaining
040967 - continuing pain from complications after knee surgery;
040968 - Robin planning 2nd opinions, and meeting with original
040969 - surgeon on 120730. ref SDS 20 N48J
040971 - ..
040972 - [On 120723 2305 Robin letter reports meeting with
040973 - Doctor Lawler on 120719, who performed knee surgery on
040974 - 120322, ref SDS 10 699F; Doctor Lawler advised that
040975 - recent MRI scan shows "frayed" knee cartiledge,
040976 - ref SDS 21 978S; which conflicts with radiologist
040977 - report finding 2 new "tears"; Robin does not report
040978 - Doctor Lawler explained cause nor prescribed treatment
040979 - to relieve continuing severe pain Robin reported on
040980 - 120718. ref SDS 20 UN6O
040982 - ..
040983 - 3. To aid consideration for additional care, please assemble
040984 - my medical chart showing labs, all progress notes, tests,
040985 - etc., on surgery performed March 22nd, and for subsequent
040986 - meetings and calls we have had to assess my progress and
040987 - plan recovery. Let me know if I need to come to your
040988 - office to sign a release form, in addition to submitting
040989 - this signed letter.
040991 - ..
040992 - 4. Please call to advise when my medical records are
040993 - assembled, so I can visit your office to receive them, thus
040994 - avoiding delay using the US mail system. Please prepare a
040995 - transmittal listing records provided by your office.
040996 - Additionally, please advise me of any other sources I need
040997 - to contact for a complete record on my surgery; for
040998 - example, does the hospital have additional documents not
040999 - available from your office?
041001 - ..
041002 - 5. After making personal review, I will obtain 2nd opinions
041003 - from medical professionals to aid your consideration and
041004 - planning for my recovery from knee surgery, including
041005 - relief of debilitating pain. Hopefully, 2nd opinions will
041006 - be available within the next 2 weeks, and submitted to your
041007 - attention, so we can meet as soon as your schedule permits
041008 - to assess solutions and prescribe care.
041010 - ..
041011 - 6. If your office cannot provide my medical chart within the
041012 - next few days, I will seek 2nd opinions concurrent with
041013 - assembly of my medical records, and request interim advice
041014 - based on my verbal representations, subject to correction
041015 - and addition on reviewing the medical chart.
041017 - ..
041018 - 7. Again, I am pleased to thank you and your office for
041019 - outstanding work on my surgery, and for excellent case
041020 - management. Complications in health care are routine.
041021 - Resolution is best achieved through collaboration and team
041022 - work.
041024 - ..
041025 - 8. Please call to advise when you expect to have my medical
041026 - records ready for me to pick up, and let me know of any
041027 - additional steps you feel I can perform to assist the team.
041038 -
041039 - **********************
041041 - ..
041042 - Testing Diagnose Severe Pain Complications Surgery Months Ago
041043 -
041044 -
041045 - 5. If you have email contact with Lawler's office, that will
041046 - expedite giving notice on getting the medical chart. Giving
041047 - the doctor written notice in this way will alert that you are
041048 - serious about getting required care. They need to do
041049 - additional tests on finding the cause of rising pain described
041050 - in your letter on 120619.
041051 -
041052 - [On 120718 1842 Robin reports knee pain worsened; MRI
041053 - radiology scan on 120717, implemented plans in the letter
041054 - to Robin on 120623, ref SDS 0 Q23N, and shows 2 new tears
041055 - which explain continuing pain from complications after
041056 - surgery on 120322, ref SDS 10 699F; Robin planning 2nd
041057 - opinions, and meeting with original surgeon on 120730.
041058 - ref SDS 20 N48J
041060 - ..
041061 - [On 120723 2205 Robin reports success advancing the meeting
041062 - scheduled for 120730 with Doctor Lawler, to 120719, and
041063 - that the doctor, who performed knee replacement surgery on
041064 - 120322, which has caused debilitating knee pain the past 4
041065 - months, provided no care nor work plan to resolve surgery
041066 - complications in order to relieve continuing pain, doctor
041067 - said to avoid impact activity like running, and offered
041068 - prognosis for knee replacement surgery in distant future.
041069 - ref SDS 21 978S
041071 - ..
041072 - 6. Monday, call Fow's office and ask if he can see you for a 2nd
041073 - opinion; if you wish, I will call them and set it up, including
041074 - ask for the cost of a 2nd opinion. I have worked with Fow and
041075 - his staff on Bob's case. I can attend the meeting with you to
041076 - help conduct a thorough, productive review of your situation.
041077 - I can put up the cash, if that is a problem. You are likely
041078 - entitled to recover the full amount from Lawler's office. At
041079 - Kaiser Millie had about 8 2nd opinions. Kaiser's rule was to
041080 - reimburse patients when Kaiser implemented 2nd opinions. They
041081 - implemented all of them; so, I expect there is some State or
041082 - Federal regulation on this issue that entitles you to get
041083 - reimbursed for 2nd opinions that lead to resolution of your
041084 - medical needs.
041086 - ..
041087 - 7. The critical point is that you need immediate care that is not
041088 - being provided by the surgeon. Physical therapy may or may not
041089 - be a solution.
041090 -
041091 - [...below on 120623 research finds state legislative
041092 - authority requiring providers pay for 2nd opinions.
041093 - ref SDS 0 QT6N
041095 - ..
041096 - [On 120629 1019 at 2226 letter from Robin reports getting
041097 - treatment for her knee with physical therapy. ref SDS 19
041098 - LK7H
041100 - ..
041101 - [On 120718 1842 Robin reports knee pain worsened; she
041102 - ordered MRI radiology scan on 120717; results show 2
041103 - new tears since surgery on 120322, explaining
041104 - continuing pain from complications after knee surgery;
041105 - Robin planning 2nd opinions, and meeting with original
041106 - surgeon on 120730. ref SDS 20 N48J
041108 - ..
041109 - 8. Have to get some sleep now. Call if you have any questions. I
041110 - don't expect you will implement anything here, because most
041111 - people feel comfortable working by conversation - what did the
041112 - chiropractor say, what did my friend say, what about the
041113 - butcher, what did Oprah say on television, etc??
041115 - ..
041116 - 9. Keep in mind that health care is complicated; it is hard to
041117 - manage for everyone. You have lots of help available if you
041118 - want it, but I understand that my approach to things seems odd.
041120 - ..
041121 - 10. Whatever you do, let me know if I can help. I'm on your side.
041122 -
041129 -
041131 - ..
0412 -
0413 -
0414 - 0532
0415 -
041501 - Research 2nd Opinion Medical Care
041502 -
041503 - Letter to Robin this morning proposes getting 2nd opinion to recover
041504 - from complications caused by knee surgery on 120322, per above.
041505 - ref SDS 0 Q241
041507 - ..
041508 - Research on Internet shows...
041509 -
041510 - 1. The Kaiser Papers...
041511 -
041512 - http://howto.kaiserpapers.org/secondop.html
041513 -
041514 - To get Kaiser to pay for an outside second or third opinion it
041515 - can be a long drawn out process. IN WRITING to member services
041516 - request a second opinion from Kaiser. If not satisfied,
041517 - request another. You have the right to three opinions before
041518 - Kaiser will pay you to have an outside of Kaiser opinion.
041519 - Sometimes they will allow it after two internal second
041520 - opinions. Kaiser will then be obligated to honor, and pay for
041521 - your request to have a consult with any outside physician of
041522 - YOUR choice. ALWAYS submit these requests in WRITING and hand
041523 - deliver them to Member Services. Request a stamped date be
041524 - placed on it and get a copy of your complaint with the stamped
041525 - date on it.
041527 - ..
041528 - You may have to pay a co-pay for the outside of Kaiser second
041529 - opinion.
041531 - ..
041532 - This information is as per California Health and Safety Law HSC
041533 - 1383.15
041534 -
041535 -
041536 - (a) When requested by an enrollee or participating health
041537 - professional who is treating an enrollee, a health care
041538 - service plan shall provide or authorize a second opinion
041539 - by an appropriately qualified health care professional.
041540 - Reasons for a second opinion to be provided or authorized
041541 - shall include, but are not limited to, the following:
041543 - ..
041544 - (1) If the enrollee questions the reasonableness or
041545 - necessity of recommended surgical procedures.
041547 - ..
041548 - (2) If the enrollee questions a diagnosis or plan of care
041549 - for a condition that threatens loss of life, loss of
041550 - limb, loss of bodily function, or substantial
041551 - impairment, including, but not limited to, a serious
041552 - chronic condition.
041554 - ..
041555 - (3) If the clinical indications are not clear or are
041556 - complex and confusing, a diagnosis is in doubt due to
041557 - conflicting test results, or the treating health
041558 - professional is unable to diagnose the condition,
041559 - and the enrollee requests an additional
041560 - diagnosis.
041562 - ..
041563 - (4) If the treatment plan in progress is not improving
041564 - the medical condition of the enrollee within an
041565 - appropriate period of time given the diagnosis and
041566 - plan of care, and the enrollee requests a second
041567 - opinion regarding the diagnosis or
041568 - continuance of the treatment.
041570 - ..
041571 - (5) If the enrollee has attempted to follow the plan of
041572 - care or consulted with the initial provider
041573 - concerning serious concerns about the diagnosis or
041574 - plan of care.
041576 - ..
041577 - (b) For purposes of this section, an appropriately qualified
041578 - health care professional is a primary care physician or
041579 - specialist who is acting within his or her scope of
041580 - practice and who possesses a clinical background,
041581 - including training and expertise, related to the
041582 - particular illness, disease, condition or conditions
041583 - associated with the request for a second opinion. For
041584 - purposes of a specialized health care service plan, an
041585 - appropriately qualified health care professional is a
041586 - licensed health care provider who is acting within his or
041587 - her scope of practice and who possesses a clinical
041588 - background, including training and expertise, related to
041589 - the particular illness, disease, condition or conditions
041590 - associated with the request for a second opinion.
041592 - ..
041593 - (c) If an enrollee or participating health professional who is
041594 - treating an enrollee requests a second opinion pursuant to
041595 - this section, an authorization or denial shall be provided
041596 - in an expeditious manner. When the enrollee's condition
041597 - is such that the enrollee faces an imminent and serious
041598 - threat to his or her health, including, but not limited
041599 - to, the potential loss of life, limb, or other major
041600 - bodily function, or lack of timeliness that would be
041601 - detrimental to the enrollee's ability to regain maximum
041602 - function, the second opinion shall be authorized or denied
041603 - in a timely fashion appropriate for the nature of the
041604 - enrollee's condition, not to exceed 72 hours after the
041605 - plan's receipt of the request, whenever possible.
041607 - ..
041608 - Each plan shall file with the Department of Managed
041609 - Health Care timelines for responding to requests for
041610 - second opinions for cases involving emergency needs,
041611 - urgent care, and other requests by July 1, 2000, and
041612 - within 30 days of any amendment to the timelines. The
041613 - time lines shall be made available to the public upon
041614 - request.
041616 - ..
041617 - (d) If a health care service plan approves a request by an
041618 - enrollee for a second opinion, the enrollee shall be
041619 - responsible only for the costs of applicable copayments
041620 - that the plan requires for similar referrals.
041622 - ..
041623 - (e) If the enrollee is requesting a second opinion about care
041624 - from his or her primary care physician, the second
041625 - opinion shall be provided by an appropriately qualified
041626 - health care professional of the enrollee's choice within
041627 - the same physician organization.
041629 - ..
041630 - (f) If the enrollee is requesting a second opinion about care
041631 - from a specialist, the second opinion shall be provided by
041632 - any provider of the enrollee's choice from any independent
041633 - practice association or medical group within the network
041634 - of the same or equivalent specialty. If the specialist is
041635 - not within the same physician organization, the plan shall
041636 - incur the cost or negotiate the fee arrangements of that
041637 - second opinion, beyond the applicable copayments which
041638 - shall be paid by the enrollee.
041640 - ..
041641 - If not authorized by the plan, additional medical
041642 - opinions not within the original physician organization
041643 - shall be the responsibility of the enrollee
041645 - ..
041646 - (g) If there is no participating plan provider within the
041647 - network who meets the standard specified in subdivision
041648 - (b), then the plan shall authorize a second opinion by an
041649 - appropriately qualified health professional outside of the
041650 - plan's provider network. In approving a second opinion
041651 - either inside or outside of the plan's provider network,
041652 - the plan shall take into account the ability of the
041653 - enrollee to travel to the provider.
041655 - ..
041656 - (h) The health care service plan shall require the second
041657 - opinion health professional to provide the enrollee and
041658 - the initial health professional with a consultation
041659 - report, including any recommended procedures or tests that
041660 - the second opinion health professional believes
041661 - appropriate. Nothing in this section shall be construed
041662 - to prevent the plan from authorizing, based on its
041663 - independent determination, additional medical opinions
041664 - concerning the medical condition of an enrollee.
041666 - ..
041667 - (i) If the health care service plan denies a request by an
041668 - enrollee for a second opinion, it shall notify the
041669 - enrollee in writing of the reasons for the denial and
041670 - shall inform the enrollee of the right to file a grievance
041671 - with the plan. The notice shall comply with subdivision
041672 - (b) of Section 1368.02.
041674 - ..
041675 - (j) Unless authorized by the plan, in order for services to be
041676 - covered the enrollee shall obtain services only from a
041677 - provider who is participating in, or under contract with,
041678 - the plan pursuant to the specific contract under which the
041679 - enrollee is entitled to health care services. The plan
041680 - may limit referrals to its network of providers if there
041681 - is a participating plan provider who meets the standard
041682 - specified in subdivision (b).
041684 - ..
041685 - (k) This section shall not apply to health care service plan
041686 - contracts that provide benefits to enrollees through
041687 - preferred provider contracting arrangements if, subject to
041688 - all other terms and conditions of the contract that apply
041689 - generally to all other benefits, access to and coverage
041690 - for second opinions are not limited.
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