THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: September 24, 2007 02:51 AM Monday; Rod Welch

Compromise proposal resolve payment dispute clinical trial referral.

1...Summary/Objective
2...UCSF Substantial Progress Resolving Clinical Trial Payment Issues
3...UCSF Continued Support Contact for Answers to Billing Questions
4...Trust Reliance on Doctor Stressful Patient Diagnostics Rising
........Double Dipping Not Justified Kaiser Break on Cost of Drugs
5...Treatment UCSF Effective Continue Financial Arrangements
6...Four (4) Problems Interjecting Medicare Between Kaiser and Patient
........Charges Blood Tests Chemotherapy
7...Compromise Solution Standard Copayments Clinical Trial Treatments


..............
Click here to comment!

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

SUBJECTS
Kaiser Senior Advantage Medicare Coverage  Nt Medigap Patient Respon

6003 -
6003 -    ..
6004 - Summary/Objective
6005 -
600501 - Follow up ref SDS 13 0000, ref SDS 12 0000.
600502 -
600503 -
600504 -
600505 -
600507 -  ..
6006 -
6007 -
6008 - Progress
6009 -
600901 - UCSF Substantial Progress Resolving Clinical Trial Payment Issues
600902 -
600903 - Follow up ref SDS 13 EZ5J, ref SDS 12 EZ5J.
600904 -
600905 - Received ref DRT 1 0001 from Bob at UCSF responding to a letter dated
600906 - 070920 to Millie's letter on 070919. ref SDS 13 EZ5J
600908 -         ..
600909 -    1.  I am a bit confused with your last email.   I just rechecked
600910 -        her Medicare coverage on line & it shows that Ms Buck has
600911 -        Kaiser because she assigned her Medicare coverage to Kaiser.
600912 -        Kaiser is not her MediGap coverage and would only make payment
600913 -        if they preauthorized specific medical services at UCSF.  This
600914 -        means the patient is responsible to pay her Medicare
600915 -        coinsurance. ref DRT 1 0001
600917 -  ..
600918 - Bob addresses Millie's understanding that Kaiser has constructive
600919 - Medigap coverage presented in a letter on 070919. ref SDS 13 I53Y
600921 -  ..
600922 - UCSF letter continues...
600923 -
600924 -    2.  A MediGap plan is one where the patient purchases insurance
600925 -        coverage to cover all or part of what Medicare does not cover.
600926 -        ref DRT 1 N66I
600928 -  ..
600929 - Research on 070917 shows Kaiser instructs customers to cancel Medigap
600930 - coverage indicating Kaiser Senior Advantage covers this scope.
600931 - ref SDS 12 EZ56
600932 -
600933 -            [...below, response to UCSF addressing Bob's understanding
600934 -            of insurance coverage flowing from Kaiser's referral for
600935 -            Millie's treatment at UCSF. ref SDS 0 UL8Y
600937 -             ..
600938 -            [On 070927 Kaiser's documentation shows on page 4 that
600939 -            Senior Advantage does not provide supplemental Medigap
600940 -            coverage, ref SDS 16 1F6L, which conflicts with Kaiser's
600941 -            representations that Kaiser Senior Advantage supplemented
600942 -            Medicare, and was all Millie needed to maintain continuity
600943 -            of treatment for cancer provided by Kaiser since 2002.
600944 -            ref SDS 16 4A9J
600946 -             ..
600947 -            [On 070927 Kaiser told Millie in 2004 that Senior Advantage
600948 -            insurance would continue her treatment for cancer.
600949 -            ref SDS 16 H75F
600951 -             ..
600952 -            [On 071018 AARP article reports widespread confusion about
600953 -            differences between Medigap supplemental Medicare policies
600954 -            and HMO insurance coverage due to misrepresentations
600955 -            selling managed care insurance cause beneficiaries to incur
600956 -            significant extra charges. ref SDS 19 CR6T
600957 -
600958 -
600959 -
6010 -

SUBJECTS
Contact UCSF Feel Free on Billing Concerns Questions Confirm Policy

7403 -
740401 -  ..
740402 - UCSF Continued Support Contact for Answers to Billing Questions
740403 -
740404 -
740405 - UCSF letter continues...
740406 -
740407 -    3.  It is good to hear that Ms.  Buck is doing better.  As always,
740408 -        please feel free to contact me with your UCSF billing concerns.
740409 -        ref DRT 1 N66N
740411 -  ..
740412 - This confirms Bob's letter on 070912 offering UCSF support for
740413 - questions on billings to Millie. ref SDS 12 H47I
740414 -
740415 -             [...below, letter thanks Bob and UCSF for good wishes on
740416 -             Millie's successful treatment. ref SDS 0 2A5J
740417 -
740418 -             [On 071009 letter from Bob Schwartz at UCSF reports asking
740419 -             Kaiser to tell the patient not to contact UCSF on billing
740420 -             issues, ref SDS 18 X65I, Millie was called by Kitty Cook
740421 -             at Kaiser who invoked HIPAA for purposes of disclosing
740422 -             private medical information to the patient, ref SDS 18
740423 -             JW7M, and then told Millie that Bob Schwartz refuses to
740424 -             communicate with the patient on resolving billing issues.
740425 -             ref SDS 18 JW59
740426 -
740427 -
740428 -
740429 -
740430 -
7405 -

SUBJECTS
Trust Reliance Doctor Stressful Patient Diagnostics Rising Kaiser Fa

B803 -
B804 - 0301
B80501 -  ..
B80502 - Trust Reliance on Doctor Stressful Patient Diagnostics Rising
B80503 -
B80504 - Submitted letter, ref DIT 1 0001, to UCSF responding to Bob's letter
B80505 - on 070920, received in the record per above. ref SDS 0 EZ5J
B80506 -
B80507 -    1.  Thanks for warm thoughts on Millie in your letter on 070920.
B80508 -        ref SDS 0 N45S, ref DIT 1 0001
B80510 -         ..
B80511 -    2.  Doctor Rugo (UCSF) and [the primary care physician at Kaiser]
B80512 -        have seen Millie through difficult times, so diagnostically she
B80513 -        is doing better than ever. [CA 15-3 drops to 28, on 070831,
B80514 -        ref SDS 9 G15I].  As you might imagine trust and reliance have
B80515 -        become stressful issues.  [The primary care physician] noticed
B80516 -        rising stress on Friday at Kaiser, ref SDS 14 QY5I, and Brigid
B80517 -        observed this the day before at UCSF for examination starting
B80518 -        the next round of treatment. ref SDS 14 BU6H  Hopefully, we can
B80519 -        relieve this with compromise discussed below. ref SDS 0 UM4U,
B80520 -        ref DIT 1 IL6H
B80522 -         ..
B80523 -    3.  As discussed in your office on 070830, Millie did not
B80524 -        self-refer for treatment at UCSF. ref SDS 8 T247  Kaiser
B80525 -        prescribed treatment made arrangements and told her to go to
B80526 -        UCSF. [on 070105, ref SDS 2 PK7L]  Correspondence between
B80527 -        Kaiser and UCSF on 061230 states Kaiser will pay for any cost
B80528 -        not covered by the clinical trial. ref SDS 1 3X6K
B80529 -        Authorization was submitted by Kaiser on 070119, ref SDS 3
B80530 -        4R4M, per the record of our meeting on 070830. ref SDS 8 T247,
B80531 -        ref DIT 1 IL7G
B80532 -
B80533 -           [On 070927 Kaiser's documentation shows on page 4 that
B80534 -           Senior Advantage does not provide supplemental Medigap
B80535 -           coverage, ref SDS 16 1F6L, which conflicts with Kaiser's
B80536 -           representations that Kaiser Senior Advantage supplemented
B80537 -           Medicare, and was all Millie needed to maintain continuity
B80538 -           of treatment for cancer provided by Kaiser since 2002.
B80539 -           ref SDS 16 4A9J
B80541 -            ..
B80542 -           [On 071018 AARP article reports widespread confusion about
B80543 -           differences between Medigap supplemental Medicare policies
B80544 -           and HMO insurance coverage due to misrepresentations selling
B80545 -           managed care insurance cause beneficiaries to incur
B80546 -           significant extra charges. ref SDS 19 CR6T
B80547 -
B80548 -
B80549 -
B80550 -
B80551 -
B806 -

SUBJECTS
Double Dip Financial Engineering Not Justified Kaiser Saves Money Cl

C603 -
C60401 -         ..
C60402 -        Double Dipping Not Justified Kaiser Break on Cost of Drugs
C60403 -
C60404 -        Follow up ref SDS 8 NQ3F.
C60405 -
C60406 -    4.  Kaiser and UCSF have expertise to accomplish fair, just payment
C60407 -        for Millie's care, demonstrated the past 6 years while she has
C60408 -        been treated for cancer under the same surety coverage Millie
C60409 -        has now.  By sending Millie to UCSF, Kaiser gets a break on the
C60410 -        cost of drugs, which [the primary care physician] mentioned on
C60411 -        Friday is a considerable cost savings to Kaiser. ref SDS 14
C60412 -        QY58  There is no reason to double-dip with financial
C60413 -        engineering to get an additional 20% payment [discussed with
C60414 -        UCSF on 070830, ref SDS 8 NQ3F], or whatever it is Kaiser has
C60415 -        calculated in telling UCSF what to bill Millie.  The primary
C60416 -        care physician indicated on Friday that Kaiser and UCSF have
C60417 -        excellent relations. ref SDS 14 CU5K  Doctor Rugo mentioned on
C60418 -        070130 that UCSF always has problems getting payments from
C60419 -        Kaiser, but eventually things work out. ref SDS 5 LY9H  Your
C60420 -        record of negotiations [reviewed on 070823] shows success
C60421 -        getting reasonable payment from Kaiser. ref SDS 7 NN71  You
C60422 -        should try again to get support for the doctor, and to perform
C60423 -        obligations to Millie. ref DIT 1 IL7Q
C60424 -
C60425 -
C60426 -
C605 -

SUBJECTS
Treatment UCSF Clinical Trial Effective Continue with Financial Arra

D803 -
D80401 -  ..
D80402 - Treatment UCSF Effective Continue Financial Arrangements
D80403 - Four (4) Problems Interjecting Medicare Between Kaiser and Patient
D80404 -
D80405 - Follow up ref SDS 8 T94H.
D80406 -
D80407 -    5.  Millie has four concerns in this matter centered on maintaining
D80408 -        care by Doctor Rugo going forward working with [the primary
D80409 -        care physician] at Kaiser, as listed in the record of our
D80410 -        meeting in your office on 070830. ref SDS 8 T94H, ref DIT 1
D80411 -        IL9L
D80412 -
D80413 -            [On 070925 telecon call with Bob seemed to indicate UCSF is
D80414 -            aware of Millie's 4 concerns listed on 070830 about
D80415 -            protecting legal rights that conflict with conisurance.
D80416 -            ref SDS 15 VE4N
D80418 -             ..
D80419 -            [On 071030 notify Kaiser of objective to develop
D80420 -            financial arrangemetns for continuing treatment at
D80421 -            UCSF. ref SDS 20 UB5S
D80423 -             ..
D80424 -            [On 071128 Kaiser Appeals Committee approved payment
D80425 -            for Millie's care on referral to UCSF. ref SDS 21 JZ5R
D80427 -         ..
D80428 -    6.  How Kaiser and UCSF work out payment is of no concern to
D80429 -        Millie.  She makes 2 insurance payments every month.  Kaiser
D80430 -        told her their coverage supplements Medicare.  This is
D80431 -        supported by research on 070917 showing Kaiser tells new
D80432 -        members they can cancel their Medigap coverage because Kaiser
D80433 -        takes care of it. ref SDS 12 EZ56, ref DIT 1 IL4J
D80434 -
D80435 -            [On 070927 Kaiser documentation saying on page 4 that
D80436 -            Senior Advantage is not supplemental, "Medigap," coverage,
D80437 -            ref SDS 16 1F6L; conflicts with Kaiser representations that
D80438 -            customers can cancel Medigap after signing up for Kaiser
D80439 -            Senior Advantage, reported on 070917, ref SDS 12 EZ56, and
D80440 -            further conflicts with Kaiser representations to Millie
D80441 -            that Senior Advantage supplements Medicare, that she did
D80442 -            not need additional insurance to maintain continuity of
D80443 -            treatment for cancer begun in 2002. ref SDS 16 4A9J
D80445 -         ..
D80446 -    7.  As you know, secondary coverage is responsible to pay for
D80447 -        coinsurance.  Accordingly, there is no reason for Millie to
D80448 -        receive 30 invoices a month with detail that would overwhelm
D80449 -        even Allen Greenspan, as shown in the record on 070830.
D80450 -        ref SDS 8 4P8K, ref DIT 1 IL4T
D80451 -
D80452 -
D80453 -
D805 -

SUBJECTS
Chemotherapy Drug Costs Paid by Clinical Trial Blood Test Laboratory

EZ03 -
EZ0401 -         ..
EZ0402 -        Charges Blood Tests Chemotherapy
EZ0403 -
EZ0405 -         ..
EZ0406 -    8.  Millie wondered why for example UCSF invoices show charges for
EZ0407 -        chemotherapy and related expenses when these costs are paid by
EZ0408 -        the clinical trial? [listed on 070830. ref SDS 8 NS4U],
EZ0409 -        ref DIT 1 IL5S
EZ0410 -
EZ0411 -            [On 070925 telecon with Bob disclosed that UCSF is
EZ0412 -            reviewing this issue to reduce confusion. ref SDS 15 VN5M
EZ0414 -             ..
EZ0415 -            [On 071009 USACE representative claims to have received
EZ0416 -            notice from unnamed people at Kaiser that the patient was
EZ0417 -            told the patient would be responsible for coinsurance in
EZ0418 -            Kaiser's transaction arranging for treatment on referral at
EZ0419 -            UCSF. ref SDS 18 N88P
EZ0421 -             ..
EZ0422 -            [On 071128 Kaiser Appeals Committee approved payment for
EZ0423 -            Millie's care on referral to UCSF. ref SDS 21 JZ5R
EZ0424 -
EZ0425 -
EZ0426 -
EZ05 -

SUBJECTS
Compromise Solution Payment Dispute Clinical Trial Coinsurance Stand

H003 -
H00401 -  ..
H00402 - Compromise Solution Standard Copayments Clinical Trial Treatments
H00403 -
H00404 -
H00405 -    9.  At this time, UCSF has billed Mil for about $1,500, as shown in
H00406 -        the record on 070917 reviewing your letter on 070912.
H00407 -        ref SDS 12 J14R, ref DIT 1 IL6N
H00409 -         ..
H00410 -   10.  I think Millie pays $30 or so for visiting the doctor at
H00411 -        Kaiser, $20 for blood tests, and nothing for treatment in the
H00412 -        infusion clinic.  She had 2 meetings a month at UCSF with the
H00413 -        medical team for 8 months, which makes 16.  $30 x 16 = $480.
H00414 -        Even though they told her at UCSF that doctor visits are paid
H00415 -        by the clinical trial, to compromise she is willing to pay this
H00416 -        amount, what ever the actual number is (your invoices vary from
H00417 -        $22 - $27).  Same for blood tests. $20 x 8 is $160.  That makes
H00418 -        a total of $640.  Millie paid $312 on 070906, so it seems she
H00419 -        owes $328.  Please explain what is being paid by the
H00420 -        approximate additional $900 UCSF seeks in its revised claim on
H00421 -        070912? ref DIT 1 IL6U
H00423 -         ..
H00424 -   11.  Thanks very much for professional, courteous work on a complex
H00425 -        issue. ref DIT 1 QF6J
H00426 -
H00427 -
H00428 -
H00429 -
H00430 -
H00431 -
H00432 -
H00433 -
H00434 -
H005 -
Distribution. . . . See "CONTACTS"