THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: August 30, 2007 08:07 AM Thursday; Rod Welch

Meet UCSF review policy procedures on billings for Millie's treatments

1...Summary/Objective
2...$10,000 UCSF Claim Annual Clinical Trial Treatments 56% Medicare Payments
3...56% Medicare Payments UCSF Charging Coinsurance $10,000 Clinical Trial
4...Clinical Trial Coinsurance 56% Medicare Payments UCSF Charging $10,000
5...Claim Not Supported by Record of Services Provided Invoice Confusing
6...Confusing Invoice No Correlation UCSF Services and Claim Against Millie
7...Negotiate Medicare Payments for Clinical Trial Services
8...Doctor Assigns Code for Billing Medicare on Established Rate Schedule
9...Justification Charges Entitlement Predicate Charity Collection Efforts
10...Collection Agencies Charities Deferred Pending Justification Charges
11...Charity Appeals Payment UCSF Pending Justification of Charges
12...Kaiser May be Rejecting Medicare Payment for Blood Tests
13...Blood Tests Lab Costs Routine Care Trials Kaiser Charges Millie
14...Account Balance Transfer Charges Not Justified Invoice Confusing
15...Invoice Confusing Account Balance Transfer Charges Not Justified
16...Chemotherapy Paid by Clinical Trial Double Billed in Invoices
17...Invoices No Correlation Medical Services and Charges to Patient
18...Lab Blood Tests Essential for Realtime Monitor Chemotherapy Care
19...Clinical Trial Referrals Expand Treatments Integral Oncology Practice
20...$10K Claim Treatment Clinical Trial Conflicts with Patient History
21...Double Dipping Savings Not Justified Kaiser Responsible Cost Standard of Care
22...Clinical Trials Prescribed by Kaiser Routinely Charge No Coinsurance
23...Self-referral Not Supported by Patient History; Kaiser Prescribes
24...Case Study Kaiser Routinely Prescribed Treatment Clinical Trials
25...Referrals Kaiser Routinely Coordinates Pays All Costs Patient Never Sees Invoice
26...Insurance Senior Advantage Since 2002 Why Extra Charges in 2007??
27...Documentation at UCSF Shows Kaiser Referred Millie for Treatment
28...Kaiser's Self-referral Theory Conflicts Patient History
29...Patient Benefits Do Not Shield Kaiser from Paying for Prescribed Care
30...Medicare Breaks Trust and Reliance between Patient and Doctor
31...Coinsurance Interim Payment Doctor Visits Pending Justification
32...Payment Dispute UCSF and Kaiser Resolution Objectives
33...Goals for Resolution Dispute between Kaiser and UCSF
34...UCSF Treatments Effective Continue Patient Objective Goals
35...4 Problems Interjecting Medicare Between Kaiser and Patient
36...Patient Agreement UCSF Obligations Discharged by Kaiser Insurance
37...Coinsurance Not Owed Kaiser Pays Costs Not Covered by Clinical Trial
38...Kaiser Says Customers May Be Charged Coinsurance for Clinical Trials
39...Doctor Visits Copayments Requested by UCSF Conflicts Clinical Trial
40...UCSF Requests Copayments Doctor Visits Identified as $101
41...Patient Agrees Copayments for Doctor Visits Same as at Kaiser


..............
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CONTACTS 
0201 - UCSF Medical Center                                                                                                                                                
020101 - Mr. Robert Zvi Schwartz, MPH                                                                                                                                     
020102 - Patient Financial Consultant  
020104 - Patient Financial Services  

SUBJECTS
UCSF Cannot Justify Claim Against Millie for Treatment Clinical Tria                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
2703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2703 -    ..
2704 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
2705 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270501 - Follow up ref SDS 31 0000. ref SDS 30 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
270502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270503 - Bob was very helpful discussing UCSF's claim against Millie for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270504 - Medicare coinsurance.  He submitted a new spreadsheet increasing the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270505 - amount to approximately $10K per year. ref SDS 0 X16N   This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270506 - calculates to 56% of the amount Kaiser's Medicare unit has paid on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270507 - UCSF billings.  This 36% more than 20% Medicare authorizes provides to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270508 - charge patients for clinical trial care. ref SDS 0 7X5G  Bob confirmed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270509 - today there is no correlation between any amount UCSF claims is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270510 - "patient responsibility" and cost of medical services listed in UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270511 - invoices.  Bob indicated Kaiser's Medicare unit may be designating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270512 - costs of blood tests as patient responsibility because Kaiser wants                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270513 - payment for performing the work, and does not want to pay UCSF for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270514 - doing lab work. ref SDS 0 T149  Review during the meeting shows blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270515 - tests are routine care covered by Medicare. ref SDS 0 636H  Bob                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270516 - further noted that the only reason Millie is receiving a lot of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270517 - invoices that add up to about $10K more per year than Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
270518 - insurance premiums is because her treatment is being performed at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270519 - rather than at Kaiser.  If the same work were performed at Kaiser,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270520 - Millie would not be faced with a claim for treatment on clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270521 - trial. ref SDS 0 NQ3F  Case study shows Kaiser has routinely                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270522 - prescribed treatment for Millie through clinical trial referral and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270523 - never claimed recovery of coinsurance. ref SDS 0 LQ5I  Recommended                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270524 - UCSF meet with Kaiser to develop a referral coordination plan that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270525 - guides work and payment responsibilities for all the parties, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270526 - gives the patient notice of any extra charges before costs are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
270527 - incurred. ref SDS 0 VT7G  UCSF requested interim payment of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270528 - coinsurance for doctor visits, based on Bob's markup of the new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270529 - spreadsheet received today and identifying amounts to pay for doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270530 - visits. ref SDS 0 W06L  Coinsurance presents four (4) issues that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270531 - require resolution. ref SDS 0 T94O  UCSF will submit justification                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270532 - showing entitlement to payment of coinsurance in this case.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270533 - ref SDS 0 V373                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
270534 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270535 -     [On 070831 letter to Jackie for copy to Doctor Rugo at UCSF, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
270536 -     copy to Doctor Johnson at Kaiser confirming understandings from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270537 -     meeting with Bob today. ref SDS 34 PX5U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270539 -      ..
270540 -     [On 070904 Millie letter to Doctor Rugo requests assistance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270541 -     resolving billing problems between Kaiser and UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
270542 -     ref SDS 35 G15I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270544 -      ..
270545 -     [On 070906 Millie submitted interim payment to UCSF for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270546 -     coinsurance, subject to justification from UCSF. ref SDS 36 EB3P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270548 -      ..
270549 -     [On 070917 UCSF revised claim reduced to $1,500, annualized                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270550 -     reduction from $10K down to about $2K per year, ref SDS 38                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270551 -     WO4O, which more than doubles copayment costs typically                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270552 -     incurred for the work involved. ref SDS 38 G68H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270554 -      ..
270555 -     [On 071006 Kaiser proposes Appeals Committee review of failure to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270556 -     perform requirements of Millie's referral to UCSF for treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270557 -     ref SDS 45 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270559 -      ..
270560 -     [On 071006 UCSF billing irregularities identified. ref SDS 45 454M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270562 -      ..
270563 -     [On 071024 propose meeting to correct problems with billings and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
270564 -     agree on interim payment. ref SDS 53 AI5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270566 -      ..
270567 -     [On 071026 UCSF billing irregularities reviewed. ref SDS 54 X18J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
270569 -      ..
270570 -     [On 071026 UCSF demands payment of claim in 1 week that conflicts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270571 -     with requirements for Kaiser to pay UCSF, and presents confusing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270572 -     and unjustified charges. ref SDS 54 SU5V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270574 -      ..
270575 -     [On 071031 Millie gets notice dated 071026 UCSF plans referral to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270576 -     collection agency for payment of $202.65 on Kaiser referral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270577 -     account 12493370, ref SDS 57 KK4I, revised 070830, ref SDS 33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270578 -     4P8K, and revised again on 070917, ref SDS 38 MK4H; no indication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270579 -     of UCSF collection efforts against Kaiser; separate notice dated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270580 -     071027 and also received 071031 UCSF says Millie's treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270581 -     cancer ordered by Kaiser will be terminated if UCSF does not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270582 -     receive payment of $202.65. ref SDS 57 KM8J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270583 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270584 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270585 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270586 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270587 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270589 -  ..
2706 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2707 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2708 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2709 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270901 - $10,000 UCSF Claim Annual Clinical Trial Treatments 56% Medicare Payments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270902 - 56% Medicare Payments UCSF Charging Coinsurance $10,000 Clinical Trial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
270903 - Clinical Trial Coinsurance 56% Medicare Payments UCSF Charging $10,000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
270904 - 
270905 - Follow up ref SDS 32 EF7L.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270907 - Background - on 061230 Kaiser arranged with UCSF to treat Millie for a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270908 - 3rd relapse of inflammatory breast cancer (IBC). ref SDS 15 PN5X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270909 - Kaiser agreed to pay UCSF any costs not covered by the clinical trial.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270910 - ref SDS 15 3X6K  On 070105 the doctor notified Millie during a meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270911 - at Kaiser that her treatment was changed from Navelbine to cetuximab                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270912 - and carboplatin on referral to UCSF. ref SDS 17 PK68                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270914 -  ..
270915 - On 070823 Millie reported having suddenly received a rash of invoices                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270916 - from UCSF backdated to January. ref SDS 30 X16N  Review showed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270917 - conflict with Kaiser's duty to pay for prescribed treatment, no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270918 - correlation between charges and services, duplication of charges,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270919 - confusing calculations (see example below, ref SDS 0 4P8K, and no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270920 - basis for determining the total amount claimed by UCSF. ref SDS 30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
270921 - 1Y9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270923 -  ..
270924 - At that time, on 070823 Bob advised in a telephone call that UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270925 - would submit a spreadsheet with UCSF's total claim to date against                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
270926 - Millie. ref SDS 30 PQRY  A week later on 070828 Millie received a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
270927 - spreadsheet showing a total claim of over $4,000. ref SDS 31 T06I  Bob                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270928 - also called later in the day and said to disregard the spreadsheet,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270929 - because new charges need to be added. ref SDS 31 PG57  At that time,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270930 - scheduled a meeting for today so that UCSF can explain the basis of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270931 - charges, and the total being claimed against Millie. ref SDS 31 PG60                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270933 -  ..
270934 - As discussed on 070828, during the meeting today Bob submitted a new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270935 - spreadsheet...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
270936 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270937 -                g: 08 02 04 60 07 08 3001a.xls                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270939 -  ..
270940 - The new cost analysis received from Bob today lists additional amounts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
270941 - UCSF claims Millie owes for getting treatment with cetuximab.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270942 - ref SDS 31 T14N  Bob said this new spreadsheet reflects more invoices                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
270943 - and statements UCSF has sent to Millie since last week on 070823.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
270944 - ref SDS 30 X16N  These invoices now number more than 70 documents, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270945 - calculate to a rate of 56% billed to Millie for coinsurance against                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270946 - amounts Kaiser has paid to UCSF through Medicare, as follows...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270948 -  ..
270949 - The UCSF spreadsheet received today shows...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270950 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270951 -        UCSF Facility Billing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
270953 -        Date:  September 30, 2007                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270954 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270955 -        <------- UCSF Services ------> <----------- Insurance --------->  Patient         Rate
270956 -          Date     Account     Charges     Payment   Adjustment  Pending  Responsibility  Percentage                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270957 -        20070130  12571560     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270958 -        20070201  12575680   $2,997.00     $752.12   $1,314.86                $910.02    120.99%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270959 -        20070201  12575738     $101.00      $89.02     -$10.28                 $22.26     25.01%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270960 -        20070301  12575761     $101.00      $89.02     -$10.28                 $22.26     25.01%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270961 -        20070208  12588856     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270962 -        20070301  12593370   $4,549.49   $1,776.54   $1,531.99              $1,240.96     69.85%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270963 -        20070315  12720616     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270964 -        20070329  12762558     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270965 -        20070426  12762597   $1,049.59     $569.74     $323.78                 $22.26      3.91%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270966 -        20070510  12762609     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270967 -        20070524  12762615   $1,094.59     $658.03     $341.35                 $22.26      3.38%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270968 -        20070405  12763636   $2,114.32     $698.82     $983.38                $432.12     61.84%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270969 -        20070503  12764302   $3,342.32   $1,186.24   $1,872.12                $283.96     23.94%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270970 -        20070419  12880922     $315.07     $125.96     $161.23                 $27.88     22.13%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270971 -        20070607  12997853     $101.00     $111.54     -$38.42                 $27.88     25.00%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270972 -        20070621  12997859     $948.59     $143.72     $749.80                 $55.07     38.32%
270973 -         ..
270974 -        20070607  12997886   $3,489.59     $821.70   $1,625.77              $1,042.17    126.83%
270975 -         ..
270976 -        20070705  12997900   $3,103.00                          $3,103.49   Not yet determined                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270977 -        20070802  12997919   $3,398.09                          $3,398.09   Not yet determined                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
270979 -         ..
270980 -        Totals..............$27,209.65   $7,580.15   $8,653.20  $6,501.09   $4,248.50                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
270982 -         ..
270983 -        TOTAL PATIENT RESPONSIBILITY AS OF 20070826........................ $4,254.12     56.05%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270984 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270985 -            [On 071018 AARP article explains many doctors and hospitals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
270986 -            will not treat Medicare patients, ref SDS 51 UF4H; the UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
270987 -            billing above illustrates that the PFFS Medicare program                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270988 -            pays health care providers below market rates. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270989 -            WP5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270991 -             ..
270992 -            [On 090604 1534 60% bankruptcies due to medical billings,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
270993 -            Reuters article reports study. ref SDS 66 QW5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
270995 -  ..
270996 - Charging 56% for coinsurance, nearly 300% more than 20% authorized by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
270997 - statute, aligns with Bob's report on 080823 that UCSF receives less                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
270998 - payment from Medicare than UCSF charges other customers. ref SDS 30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
270999 - P28L  This creates pressure on the accounting department to be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
271000 - creative with financial engineering that overcharges "soft targets" of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271001 - elderly, fragile Medicare customers for coinsurance, who are unable to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271002 - navigate massive complex billings, nor to notify the accounting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271003 - department to submit corrected and comprehensible billings based on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
271004 - services provided.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271006 -             ..
271007 -            [On 070917 research of Title 42 part 419.40 indicates 20%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
271008 -            minimum rate of coinsurance for payment on various types                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
271009 -            (APC groups) of medical services are determined annually by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271010 -            Medicare which suggests these amounts are known in advance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
271011 -            of entering treatment agreements. ref SDS 38 4Q3I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271013 -             ..
271014 -            [On 071018 AARP article explains many doctors and hospitals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
271015 -            will not treat Medicare patients, ref SDS 51 UF4H; the UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
271016 -            billing above illustrates that the PFFS Medicare program                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
271017 -            pays health care providers below market rates. ref SDS 33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
271018 -            WP5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271020 -             ..
271021 -            [On 081007 1130 over-billings for health care shown by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
271022 -            Richard's experience being billed $300,000 for 10-days care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271023 -            in the hospital to recover from blood clot. ref SDS 59 IV6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
271025 -             ..
271026 -            [On 081016 Millie's doctor at UCSF had similar experience                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
271027 -            getting overcharged for medical services, and then harassed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271028 -            for 2 years. ref SDS 60 7N7H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
271030 -             ..
271031 -            [On 090223 0947 dentist billed $17,000 for son's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271032 -            examination in hospital Emergency Department for 3 hours                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
271033 -            and for which no treatment was required. ref SDS 64 K06O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
271035 -  ..
271036 - UCSF requests a new total amount today of $4,254.12, as of 070826,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271037 - which is 56% of Medicare payments ($7,580.15) shown in the UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271038 - spreadsheet.  Bob noted the bottom of the list has 2 "pending" charges                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271039 - totaling $6,501.09, which have not been reviewed by Medicare to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271040 - determine how much UCSF will bill Millie. ref SDS 0 OT8M  He said that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271041 - Millie will likely be billed an additional $1,500 after UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
271042 - negotiates with Kaiser's Medicare people, in accordance with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
271043 - procedures discussed last week on 070823. ref SDS 30 RW3R  Since that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
271044 - time, Millie has continued to receive invoices, statements, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271045 - documents from UCSF and Kaiser aimed at getting Millie to pay over                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271046 - 500% more for treatment than agreed through her insurance coverage, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
271047 - discussed in correspondence between Kaiser and UCSF on 061230.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
271048 - ref SDS 15 3X6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
271049 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
271050 -     [On 070906 Kaiser's guidance calls for clinical trial provider to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
271051 -     disclose costs before starting treatments in a clinical trial,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271052 -     ref SDS 36 SC71; clinical trial director did not know patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
271053 -     would be charged out-of-pocket expenses. ref SDS 36 I49K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271055 -  ..
271056 - Based on UCSF's current claim of about $6K for 3 months of treatment,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
271057 - a rough estimate of the UCSF claim projected for an entire year of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271058 - weekly treatments required by the clinical trial protocol is about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271059 - $24K added to about $2K per year she already pays for health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
271060 - insurance.  More problematic is UCSF billing practice of demanding                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271061 - payment for services not performed, indicating that without careful                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
271062 - scrutiny, UCSF may claim upwards of $40K per year.  This conflicts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
271063 - with Kaiser's agreement on 061230 to pay any costs not covered by the