CONTACTS 
0204 - UCSF Medical Center                                                                                                                                                O-00000875 0305
020401 - Mr. Robert Zvi Schwartz, MPH                                                                                                                                     O-00000875 0305
020402 - Patient Financial Consultant
020404 - Patient Financial Services

SUBJECTS
UCSF Billings Payments Treatments Cancer IBC Referral Kaiser Senior

1603 -
1603 -    ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 4 0000, ref SDS 3 0000.
160502 -
160503 -
160504 -
160505 -
160506 -
160507 -
160509 -  ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - Called Yolanda and left message asking about results of her research
160902 - into why Millie owes more to UCSF than Medicare has paid. ref SDS 4
160903 - HT6N
160904 -
160905 -
160907 -  ..
1610 -
1611 -
1612 - 1006
1613 -
161301 - Called Bob about meeting on Thursday to review progress on completing
161302 - the spreadsheet, per planning on 070823. ref SDS 4 PQRY
161304 -  ..
161305 - Talked to Tenika.
161307 -  ..
161308 - She checked the record and it shows Bob sent a spreadsheet to Millie
161309 - yesterday on 070829.
161310 -
161312 -  ..
1614 -
1615 -
1616 - 1021
1617 -
161701 - After the call to UCSF, Millie checked the mailbox.  She received a
161702 - letter from UCSF with the spreadsheet Bob prepared.  It shows UCSF
161703 - seeks recovery from Millie of a claim for over $4K.  Millie was very
161704 - upset, emotional, and shocked since the primary care physician made
161705 - the referral on 070105, ref SDS 2 PK68, based on understandings Kaiser
161706 - would pay for all costs not covered by the clinical trial, reported on
161707 - 061230. ref SDS 1 3X6K  Millie feels she cannot afford to continue
161708 - treatment in the clincial trial at UCSF and will have to return to
161709 - Kaiser for whatever treatment Kaiser can offer within her budget
161710 - paying premiums for Medicare and Kaiser insurance.
161711 -
161712 -
161714 -  ..
1618 -
1619 -
1620 - 1103
1621 -
162101 - Bob called.
162102 -
162103 - Advised Millie received the UCSF spreadsheet, per above. ref SDS 0
162104 - T06I  Explained that Millie disputes the UCSF claim, because there is
162105 - no evident justification, amounts claimed for recovery are not
162106 - supported, and Kaiser is required to pay for costs not paid by the
162107 - clincial trial.
162109 -  ..
162110 - Bob said to disregard the spreadsheet received today, because UCSF has
162111 - revised and increased the claim for recovery from Millie.
162112 -
162113 -     [On 070829 Arlette at Kaiser very surprised referral patient would
162114 -     received claim of over $4K for clinical trial from service
162115 -     provider. ref SDS 5 EG34
162117 -  ..
162118 - Bob will submit an updated spreadsheet Thursday.
162120 -  ..
162121 - Scheduled meeting on Thursday 070830 0900 to give UCSF a chance to
162122 - explain and justify its claim.
162124 -  ..
162125 - Bob suggested calling before leaving UCSF on Divisadero to travel for
162126 - the meeting at the Harrison Street office.
162128 -  ..
162129 - Bob advised that UCSF Medical Center patients are responsible for
162130 - making independent review of Medicare requirements in order to
162131 - reconcile UCSF claims for payment from the patient.
162132 -
162133 -
162134 -
162135 -
162137 -  ..
1622 -
1623 -
1624 - 1025
1625 -
162501 - Called Barbara at Kaiser Outside Referrals.
162502 -
162503 - Left message to find number for contacting Medicare to find the basis
162504 - of payments.
162506 -  ..
162507 - Called Arlette.
162509 -  ..
162510 - She was able to transfer the call to Barbara.
162512 -  ..
162513 - Talked to Barbara.
162515 -  ..
162516 - She believes that Medicare pays all reasonable and necessary costs of
162517 - clinical trials.  Providers agree to accept payment from Medicare,
162518 - and so cannot bill patients for additional costs.
162520 -  ..
162521 - Exception might be...
162522 -
162523 -        Millie's emergency treatment on 070607 for cellulitis.
162524 -
162525 -        INR blood tests for Coumadin, which should be paid by Kaiser.
162526 -
162528 -  ..
1626 -
1627 -
1628 - 1049
162901 -  ..
162902 - Medicare Benefits Specialists....
162903 -
162904 -                     800 633 4227
162906 -  ..
162907 - Called and talked to Kimberly.
162909 -  ..
162910 - She said the regulations are very confusing.  Kimberly asked for
162911 - feedback on what we find out in this case involving outside referral
162912 - for clinical trial of a member enrolled in Kaiser Senior Advantage.
162913 -
162914 -               925 295 7635
162915 -
162916 -
162917 -
162918 -
162919 -
162920 -
162921 -
162922 -
162923 -
1630 -