CONTACTS 

SUBJECTS
Kaiser Review Millie Treatment UCSF Failure  Prform Duty Pay Costs R

5103 -
5103 -    ..
5104 - Summary/Objective
5105 -
510501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
510502 -
510503 -
510504 -
510505 -
510507 -  ..
5106 -
5107 -
5108 - Progress
5109 -
510901 - Submitted ref DIT 1 0001 letter with additional background to
510902 - facilitate Kaiser's review of requirements for payment of Millie's
510903 - treatment on referral to UCSF prescribed by the primary care
510904 - physician, and following up the letter to Kaiser last week on 070926,
510905 - ref SDS 14 4I5G, and supplementing the letter the day before on
510906 - 070925, ref SDS 13 JZ7G, which included attachments with patient
510907 - history. ref SDS 13 J16G  Submitted copy to Bob at UCSF demonstrating
510908 - efforts to resolve payment issues.
510910 -  ..
510911 - Letter to Karen at Kaiser says...
510912 -
510913 -        I tried to call today with new information that may assist
510914 -        review of this matter, per your letter on Sep 26. ref SDS 14
510915 -        4I5G  However, I seem to have misplaced your number.
510916 -        ref DIT 1 0001
510917 -
510918 -
510919 -
5110 -

SUBJECTS
Clinical Trial Self-referral Patients Volunteer Contribute Advance M

7203 -
720401 -  ..
720402 - Clinical Trials Patients Self-refer to Advance Medical Science
720403 -
720404 -
720405 -    3.  Last week Millie was concerned about delay resolving payment
720406 -        issues.  She suggested we attend a cancer support group event
720407 -        that included discussion of clinical trials.  On Saturday
720408 -        Doctor Svahn, with Diablo Valley Medical Group presented
720409 -        oncology practice centered on doctor/patient partnership.  The
720410 -        doctor explained patients can self-refer to participate in
720411 -        clinical trials for scientists developing new treatments to
720412 -        help future patients.  The doctor urged patients to volunteer
720413 -        as a way of contributing to better care for everyone.  As you
720414 -        know, Kaiser has a strong doctor/patient partnership program,
720415 -        called out in the Healthwise Handbook. ref DIT 1 H76I
720416 -
720417 -
720418 -
7205 -

SUBJECTS
20% Coinsurance Charges Self-refer Clinical Trials Advance Medical S

9603 -
960401 -         ..
960402 -        Coinsurance 20% Self-referal Clinical Trials UCSF Charges 56%
960403 -
960405 -         ..
960406 -    4.  When I met with Bob Schwartz in the UCSF Accounting Department
960407 -        on August 30th, he explained patients who self-refer for
960408 -        treatment in clinical trials are charged coinsurance.
960409 -        ref SDS 8 T24Q  At the time, UCSF did not know the basis of
960410 -        charges. ref SDS 8 WU5N  Subsequent review on 070917 indicates
960411 -        statutory minimum is 20%, ref SDS 9 4Q3I, however, nobody at
960412 -        Kaiser or UCSF had ever heard of coinsurance.  The UCSF
960413 -        spreadsheet Bob submitted on 070830 calculates an aggregate
960414 -        rate of 56.02% charged to Millie for treatment in the clinical
960415 -        trial, which annualized is about $10K, nearly 10 times the cost
960416 -        of insurance premiums Millie pays to Kaiser. ref SDS 8 H54O
960417 -
960418 -
960419 -
9605 -

SUBJECTS
Kaiser Prescribed Treatment Referral UCSF Clinical Trial Perform Dut

AL03 -
AL0401 -         ..
AL0402 -        Kaiser Prescribed Millie's Treatment on Referral to UCSF
AL0403 -
AL0404 -
AL0405 -    5.  This charge is incorrect in Millie's case.  She did not
AL0406 -        self-refer.  As discussed with Bob on 070830 Kaiser has
AL0407 -        prescribed all treatments. ref SDS 8 LQ5I
AL0409 -         ..
AL0410 -    6.  On 040318 Millie objected to treatment in a clinical trial, and
AL0411 -        approved this work only on assurance this was part of Kaiser's
AL0412 -        oncology practice to prescribe the best treatment for her
AL0413 -        condition. ref SDS 1 PU6M
AL0415 -         ..
AL0416 -    7.  This happened again on 041130. ref SDS 2 028N
AL0418 -         ..
AL0419 -    8.  This happened again on 070105. ref SDS 4 PK7L
AL0421 -         ..
AL0422 -    9.  At no time was she ever advised of extra charges, and at no
AL0423 -        time was she ever charged for more than her annual insurance
AL0424 -        premiums.  This presents a dilemma of justification.  How can
AL0425 -        Kaiser now order the patient to pay an extra $10K per year for
AL0426 -        the same work? (UCSF reduced the amount of their claim being
AL0427 -        calculated by Kaiser, but the amount has not been established,
AL0428 -        and this delay causes significant trauma to a patient whose
AL0429 -        health reacts to anxiety, shown by rise of Millie's cancer
AL0430 -        marker, blood pressure, etc., noted in the medical chart for
AL0431 -        examination at Kaiser on 070921. ref SDS 10 QY5I, ref DIT 1
AL0432 -        H746
AL0434 -         ..
AL0435 -   10.  Millie does not seek to avoid payment for health care.  Her
AL0436 -        history shows prompt payment of all amounts owed.  In a letter
AL0437 -        on 070924 she offered to make the same payments for the current
AL0438 -        treatment that was charged for prior clinical trials, even
AL0439 -        though in this case UCSF indicated costs of doctor visits are
AL0440 -        paid by the trial sponsor. ref SDS 11 UM4U  On 070917 Millie
AL0441 -        received a letter from UCSF that seemed to correct prior
AL0442 -        billings. ref SDS 9 595P
AL0443 -
AL0445 -         ..
AL0446 -        UCSF Management Reviewing Claim Against Millie
AL0447 -
AL0448 -   11.  Last week Bob Schwartz advised in a call that this matter is
AL0449 -        under review by UCSF management [reported on 070925,
AL0450 -        ref SDS 12 VE5M], who in turn have contacts at Kaiser.
AL0451 -        Possibly, you and Bob can collaborate to facilitate payments to
AL0452 -        UCSF for referral, as Kaiser has done previously, and promised
AL0453 -        to do in this case on 061230. ref SDS 3 3X6K
AL0455 -         ..
AL0456 -   12.  Thanks again for assistance; please let us know progress so we
AL0457 -        can get this behind.
AL0459 -         ..
AL0460 -   13.  Sincerely,
AL0462 -         ..
AL0463 -   14.  Rod
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AL0471 -
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AL05 -