THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: October 9, 2007 04:44 PM Tuesday;
UCSF objects to justifying charges offers loans and charity to aid payment.
2...UCSF Asks Kaiser to Tell Patient Send Questions on UCSF Billings to Kaiser
3...Emotional Stress Payment Dispute Driven Threaten Stave IV Cancer Patient
4...Kaiser Helps UCSF Collect Payment from Patient Owed by Kaiser
5...HIPAA Misrepresented Bill Collection Sensitive Medical Information
6...Kaiser Calls Bill Collection for UCSF Sensitive Medical Information
7...HIPAA Entitles Patient to Medical Records and to Submit Corrections
........HIPAA - Health Information Portability and Accountability Act
8...Health Care Professional Stress Cannot Help Emotionally Stressed Patient
9...UCSF Received Verbal Written Assurance Patient Informed Coinsurance
10...UCSF Offers Payment Assistance to Patient Rather than Kaiser
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UCSF Billing Irregularities Requests Kaiser Assistance Force Patient
6203 - ..
6204 - Summary/Objective
620501 - Follow up ref SDS 10 0000.
620508 - ..
6208 - Progress
620901 - UCSF Asks Kaiser to Tell Patient Send Questions on UCSF Billings to Kaiser
620903 - Follow up ref SDS 12 X58I, ref SDS 11 0001.
620905 - Millie received rex DRT 1 0001, a letter dated today from Bob at UCSF
620906 - responding to a copy of the letter on 071007, ref SDS 12 X58I,
620907 - confirming that Kaiser is working on paying UCSF for medical services
620908 - to treat Millie in a clinical trial in accordance with Kaiser's
620909 - referral on 061230. ref SDS 2 3X6K
620911 - ..
620912 - UCSF letter says...
620914 - 1. I just spoke with Kitty C at Kaiser (phone number 1 800 464
620915 - 4000) who said she would call you today to reconfirm that any
620916 - billing issues for ******* need to be directed to Kaiser, not
620917 - UCSF Medical Center. ref DRT 1 0001
620919 - ..
620920 - Bob's letter from UCSF continues below... ref SDS 0 N88P
620922 - ..
620923 - Seems unclear why UCSF would respond to good news on 071007 that
620924 - Kaiser is working to pay UCSF billings, ref SDS 12 X58I, by telling
620925 - the patient to contact Kaiser about terms and conditions of payment
620926 - which were arranged on 061230 entirely between UCSF and Kaiser,
620927 - ref SDS 2 3X6K, and in which the patient had no involvement.
620929 - [...below, Kitty invokes HIPAA to tell Millie UCSF does not
620930 - want communications on solving billing problems.
620931 - ref SDS 0 KP5H
620933 - ..
620934 - [On 071026 billing irreglarities make health care major
620935 - challenge for everyone. ref SDS 14 X18J
620937 - ..
620938 - [On 071128 Kaiser Appeals Committee approved payment for
620939 - Millie's care on referral to UCSF. ref SDS 15 JZ5R
Kaiser Calls Emotional Stressed Stage IV Cancer Patient Misrepresent
A10401 - ..
A10402 - Emotional Stress Payment Dispute Driven Threaten Stave IV Cancer Patient
A10403 - Kaiser Helps UCSF Collect Payment from Patient Owed by Kaiser
A10404 - HIPAA Misrepresented Bill Collection Sensitive Medical Information
A10405 - Kaiser Calls Bill Collection for UCSF Sensitive Medical Information
A10407 - Millie received a call this morning from Kitty at Kaiser. Kitty was
A10408 - emotional and would not give her name, Kaiser ID, department, phone
A10409 - number, nor email address to confirm what she said. Kitty hung up
A10410 - when asked for identification, per below. ref SDS 0 KP61
A10412 - ..
A10413 - Difficulty coping with emotional trauma presented by complex problems
A10414 - was addressed by Millie's doctor during the meeting at Kaiser on
A10415 - 070921. ref SDS 8 QY9V Complexity of Millie's patient history is
A10416 - shown in case study reported on 061020. ref SDS 1 T25H
A10418 - ..
A10419 - At the time of the call, Millie was resting in bed.
A10421 - ..
A10422 - Kitty was adament insisting she could only talk to Millie. She said
A10423 - that HIPAA regulations require conveying sensitive medical information
A10424 - only directly to the patient. She asked that Millie be awakened and
A10425 - called to the telephone to personally take Kitty's call.
A10427 - [On 090219 1315 HIPPA cited for preventing submission of
A10428 - patient medical records to the patient. ref SDS 16 9O6L
A10430 - ..
A10431 - [On 100701 0915 Carol, representing herself as Chief of
A10432 - Hospice, asked to wake Millie up to talk directly about
A10433 - Carol having been told that Millie wants to dis-enroll from
A10434 - Hospice; Carol insisted that HIPAA entitles her to evaluate
A10435 - Millie's intent on the telephone, without having ever met
A10436 - Millie nor read the record of patient history; Millie
A10437 - explained she wants to continue in Hospice for pain relief
A10438 - from chemotherapy until Kaiesr responds to her claim for
A10439 - standard of care to recover from UCSF medical mistakes;
A10440 - Millie will consider dis-enrolling from Hospice when Kaiser
A10441 - explains choices for recovery. ref SDS 22 036C
HIPAA Health Information Portability and Accountability Act Entitles
A90401 - ..
A90402 - HIPAA Entitles Patient to Medical Records and to Submit Corrections
A90404 - Research shows HIPAA requirements to protect privacy of personal
A90405 - health information are listed on the Internet...
A90407 - United States Department of Health & Human Services
A90408 - Office for Civil Rights
A90409 - Medical Privacy
A90410 - National Standards to Protect the Privacy of Personal Health Information
A90412 - ..
A90413 - HIPAA - Health Information Portability and Accountability Act
A90415 - ..
A90416 - Beginning 030413.
A90418 - US Department of Health and Human Services (HHS)
A90420 - ..
A90421 - Office of Civil Rights
A90423 - ..
A90424 - Health Information Privacy
A90426 - ..
A90427 - Health Insurance Portability and Accountability Act
A90428 - (HIPAA) 1996
A90431 - http://www.hhs.gov/ocr/privacy/index.html
A90433 - ..
A90434 - The Office for Civil Rights enforces the HIPAA Privacy Rule,
A90435 - which protects the privacy of individually identifiable health
A90436 - information, and the confidentiality provisions of the Patient
A90437 - Safety Act, which protects identifiable information being used
A90438 - to analyze patient safety events and improve patient safety.
A90440 - ..
A90441 - Access. Except in certain circumstances, individuals have the
A90442 - right to review and obtain a copy of their protected health
A90443 - information in a covered entity's designated record set.55 The
A90444 - "designated record set" is that group of records maintained by
A90445 - or for a covered entity that is used, in whole or part, to
A90446 - make decisions about individuals, or that is a provider's
A90447 - medical and billing records about individuals or a health
A90448 - plan's enrollment, payment, claims adjudication, and case or
A90449 - medical management record systems.56 The Rule excepts from the
A90450 - right of access the following protected health information:
A90451 - psychotherapy notes, information compiled for legal
A90452 - proceedings, laboratory results to which the Clinical
A90453 - Laboratory Improvement Act (CLIA) prohibits access, or
A90454 - information held by certain research laboratories. For
A90455 - information included within the right of access, covered
A90456 - entities may deny an individual access in certain specified
A90457 - situations, such as when a health care professional believes
A90458 - access could cause harm to the individual or another. In such
A90459 - situations, the individual must be given the right to have
A90460 - such denials reviewed by a licensed health care professional
A90461 - for a second opinion.57 Covered entities may impose
A90462 - reasonable, cost-based fees for the cost of copying and
A90463 - postage.
A90465 - [On 091112 0930 Doctor Johnson reports that Millie's health
A90466 - care benefits from getting communications among the medical
A90467 - team at UCSF and Kaiser by providing transparency that
A90468 - encourages timely, accurate work to avoid mistakes, and
A90469 - providing analysis showing alignment with the record on
A90470 - objectives, requirements, and commitments that makes case
A90471 - management effective for Millie's survival. ref SDS 17 4W8K
A90473 - ..
A90474 - [On 091112 0930 Millie asked Doctor Johnson for all
A90475 - communications between UCSF and Kaiser on her care; Doctor
A90476 - Johnson could not find any such communications, and cited
A90477 - guidance at Kaiser that HIPAA deny's patients access to
A90478 - communications on their care. ref SDS 17 LQ5N
A90480 - ..
A90481 - [On 091210 0950 Millie asks Doctor Johnson for Kaiser's
A90482 - medical records communicating with UCSF on the UCSF work
A90483 - plan for Millie to recover from medical mistakes.
A90484 - ref SDS 18 OJ9F
A90486 - ..
A90487 - [On 100502 0140 Millie notifies Kaiser and UCSF she waives
A90488 - right to confidential health records in order exercise her
A90489 - right to health using efficient public domain email because
A90490 - patient history using securemail encrypted to protect
A90491 - confidential health records shows this causes chronic
A90492 - failure to communicate in time to be effective. ref SDS 19
A90493 - CO3W
A90495 - ..
A90496 - [On 100504 1609 Sara, Practice Manager for UCSF Oncology
A90497 - Breast Care Clinic, called and notified Millie that lawyers
A90498 - in the UCSF Risk Management Department want Millie to use
A90499 - secure email to comply with Federal regulations; Sara does
A90500 - not know what Federal regulations apply in this case, nor
A90501 - what the regulations say that justify denying the patient
A90502 - the right to choose the level of confidentiality suited to
A90503 - the patients need for communicating effectively with her
A90504 - medical team, and with transparency that encourages
A90505 - accuracy and timeliness. ref SDS 20 ZV6M
A90507 - ..
A90508 - [On 100601 0830 Doctor Johnson reported he received
A90509 - securemail from Doctor Rugo at UCSF encrypted to protect
A90510 - confidentiality of Millie's health records, but he could
A90511 - not open the letter; he sent Doctor a securemail advising
A90512 - he could not open her securemail, and he received back a
A90513 - public domain email from Doctor Rugo that she could not
A90514 - open Doctor Johnson's letter from Kaiesr; as a result of
A90515 - failed communcation with email and telephone for over a
A90516 - month, Doctor Johnson was unable to prescribe treatment for
A90517 - Millie to recover from medical mistakes getting radiation
A90518 - treatments at UCSF on referral from Kaiser; resulting in
A90519 - Millie being forced into Hospice to die. ref SDS 21 D658
A90521 - ..
A90522 - Another HHS source summarizes HIPAA requirements...
A90524 - Your Health Information Privacy Righs
A90526 - http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf
A90528 - You can ask to see and get a copy of your medical record and
A90529 - other health information. You may not be able to get all of
A90530 - your information in a few special cases. For example, if your
A90531 - doctor decides something in your file might endanger you or
A90532 - someone else, the doctor may not have to give this information
A90533 - to you.
A90535 - ..
A90536 - HIPAA requires service providers to add information to the medical
A90537 - chart showing corrections submitted by the patient...
A90539 - ..
A90540 - Have corrections added to your health information.
A90542 - ..
A90543 - You can ask to change any wrong information in your file or add
A90544 - information to your file if it is incomplete. For example, if
A90545 - you and your hospital agree that your file has the wrong result
A90546 - for a test, the hospital must change it. Even if the hospital
A90547 - believes the test result is correct, you still have the right
A90548 - to have your disagreement noted in your file.
A90550 - In most cases the file should be changed within 60 days,
A90551 - but the hospital can take an extra 30 days if you are given
A90552 - a reason.
Kaiser Calls Emotional Stressed Stage IV Cancer Patient Misrepresent
BG0401 - ..
BG0402 - Health Care Professional Stress Cannot Help Emotionally Stressed Patient
BG0404 - Explained that Millie has been upset by erroneous, complex, confusing
BG0405 - UCSF billings reported recently when Kaiser called on 071006 and
BG0406 - Millie was unable to take the call. ref SDS 11 ZE9H Millie's doctor
BG0407 - prescribed medication to treat for stress arising from billing
BG0408 - problems, reported on 070921. ref SDS 8 QY9V Patient assistance helps
BG0409 - Millie focus on recovery by avoiding worry that compounds stress
BG0410 - suffering from 45 medical issues, listed on 070524, ref SDS 3 LU3J,
BG0411 - illustrated by the call from Kaiser a few days ago on 071006.
BG0412 - ref SDS 11 Q998
BG0414 - ..
BG0415 - Kitty explained her job is very stressful communicating with difficult
BG0416 - patients on taking medical action Kaiser determines is needed.
BG0418 - ..
BG0419 - Kitty was aware that Millie has assistance. She was adament that her
BG0420 - call today involved sensitive, critical medical information which
BG0421 - HIPAA regulations required being conveyed only to Millie. Kitty was
BG0422 - asked if Kaiser could send a letter addressed to Millie, since Kitty
BG0423 - has never met Millie and would not know her from anyone else in a
BG0424 - first time telephone call?
BG0426 - ..
BG0427 - Kitty advised that her information is urgent, and asked to talk to
BG0428 - Millie immediately. She seemed willing to talk to anyone with an
BG0429 - evident female voice, and mentioned having been warned not to talk to
BG0430 - the patient assistant.
BG0432 - ..
BG0433 - Millie talked to Kitty.
BG0435 - ..
BG0436 - Kitty said in a loud, abusive tone and language toward Millie that she
BG0437 - received a call from Bob Schwartz with UCSF Accounting Department
BG0438 - complaining to Kaiser about receiving improper, repetitive,
BG0439 - unnecessary correspondence through email from Millie and her
BG0440 - representative asking for explanations of UCSF billings, and reporting
BG0441 - efforts to resolve payment dispute between UCSF and Kaiser.
BG0443 - [On 071128 Kaiser Appeals Committee approved payment for
BG0444 - Millie's care on referral to UCSF. ref SDS 15 JZ5R
BG0446 - ..
BG0447 - [On 100723 1810 Millie received another call from someone
BG0448 - claiming to represent Kaiser, and insisting on talking only
BG0449 - to Millie about sensitive medical information, and was told
BG0450 - to submit questions in writing. ref SDS 23 036C
BG0452 - ..
BG0453 - Millie asked if correspondence on UCSF billings should be sent to
BG0454 - Kitty? Has she been assigned to work this issue at Kaiser?
BG0456 - ..
BG0457 - Kitty said she knows nothing about it. She is only doing a favor for
BG0458 - Bob, because he called and asked her to tell the "deadbeat" patient
BG0459 - that UCSF does not want correspondence and calls from the patient on
BG0460 - efforts to solve billing problems; an example is the copy sent to Bob
BG0461 - of a recent letter on 071007 relating good news that Kaiser is working
BG0462 - on resolving billing dispute with UCSF in Millie's case. ref SDS 12
BG0463 - X58I Kitty's explanation that UCSF refuses to participate in resolving
BG0464 - billing problems with Kaiser seems to align with the letter from UCSF,
BG0465 - which Millie received from Bob this morning, per above. ref SDS 0 X65I
BG0467 - ..
BG0468 - UCSF refusal to discuss billings conflicts with Bob's letter to Millie
BG0469 - on 070924 offering close communication on billing issues. ref SDS 9
BG0470 - N45S
BG0472 - [On 071026 billing irreglarities make health care major
BG0473 - challenge for everyone. ref SDS 14 X18J
BG0475 - ..
BG0476 - Millie asked if Kitty knows who at Kaiser can address this, since she
BG0477 - has asked her doctor, and he could not help, reported on 070907.
BG0478 - ref SDS 6 XH5H
BG0480 - ..
BG0481 - Kitty said she doesn't know what should be done.
BG0483 - [On 071128 Kaiser Appeals Committee approved payment for
BG0484 - Millie's care on referral to UCSF. ref SDS 15 JZ5R
BG0486 - ..
BG0487 - Millie asked Kitty for her department and phone number.
BG0489 - ..
BG0490 - Kitty hung up.
BG0492 - ..
BG0493 - Called Kaiser using the number for Kitty C in the letter from from Bob
BG0494 - Schwartz at UCSF, 1 800 464 4000, per above, ref SDS 0 N87V,
BG0496 - ..
BG0497 - Got a message saying...
BG0499 - If you are a member press 1.
BG0501 - If you are a service provider press 2.
BG0503 - ..
BG0504 - There was no option to connect with Kitty C.
BG0506 - ..
BG0507 - Eventually an operator came on the line.
BG0509 - ..
BG0510 - After considerable discussion with the operator, she transferred the
BG0511 - call to...
BG0513 - Kitty Cook
BG0515 - ...left message asking if she is the Kitty C who was contacted by UCSF
BG0516 - and placed a call, per above, ref SDS 0 JW7M, and as set out in UCSF's
BG0517 - letter today. ref SDS 0 N87V
UCSF Claims Notice from Kaiser Patient Received Verbal Written Notic
CF0401 - ..
CF0402 - UCSF Received Verbal Written Assurance Patient Informed Coinsurance
CF0404 - Follow up ref SDS 9 UM3V.
CF0406 - UCSF letter from Bob Schwartz continues...
CF0408 - 2. We have been informed by Kaiser that there is verbal & written
CF0409 - confirmation that Ms. Buck was informed that she would be
CF0410 - responsible for the coinsurance. ref DRT 1 PI6G
CF0412 - [On 071010 Millie's letter to UCSF refutes allegations that
CF0413 - Kaiser disclosed coinsurance charges prior to making
CF0414 - referral for Millie's care at UCSF. ref SDS 13 HZ9P
CF0416 - ..
CF0417 - This part of the UCSF letter seems to address, though obliquely, the
CF0418 - question in the letter to UCSF on 070924 asking about the basis for
CF0419 - coinsurance charges on chemotherapy and related expenses in UCSF
CF0420 - invoices, which were originally represented to be paid by the clinical
CF0421 - trial. ref SDS 9 UM3V
CF0423 - ..
CF0424 - UCSF letter today citing coinsurance, ref SDS 0 N88P, may also address
CF0425 - the record on 071006 submitted to UCSF with the copy of the letter to
CF0426 - Kaiser on 071007, relating progress on solving Kaiser's problems
CF0427 - getting payment to UCSF. ref SDS 12 IE3R The basis for Kaiser's work
CF0428 - to pay UCSF rests on being responsible for any costs not paid by the
CF0429 - clinical trial, noted on 071006. ref SDS 11 TL98 At that time, Kaiser
CF0430 - requested background on their duty to pay for the referral work for
CF0431 - Millie at UCSF. ref SDS 11 Q969
CF0433 - ..
CF0434 - UCSF should submit information from Kaiser showing alleged notice to
CF0435 - patient responsibility for coinsurance, so this can be investigated
CF0436 - and corrected. Nameless representations are not constructive and only
CF0437 - delay solution by giving people false hope that an incorrect position
CF0438 - has support in the record. UCSF was notified on 070830 that Kaiser
CF0439 - made the referral for Millie's care at UCSF, and there is no basis for
CF0440 - coinsurance. ref SDS 4 ZS6M This is supported by correspondence
CF0441 - between Kaiser and UCSF listed on 070830. ref SDS 4 T247
CF0443 - ..
CF0444 - At that time on 070830 Bob examined the letter from Kaiser showing
CF0445 - Kaiser's agreement with UCSF to pay for any costs not covered by the
CF0446 - clinical trial, and noted there was no requirement for the patient to
CF0447 - pay coinsurance. ref SDS 4 T14K
CF0449 - [On 071010 Millie's letter to UCSF refutes allegations that
CF0450 - Kaiser disclosed coinsurance charges prior to making
CF0451 - referral for Millie's care at UCSF. ref SDS 13 HZ9P
CF0453 - ..
CF0454 - It is unclear why employees at UCSF would spend so much time and
CF0455 - emotional capital trying to extract payment from a sick patient who
CF0456 - owes UCSF nothing, while making no attempt to collect from Kaiser who
CF0457 - owes payment to UCSF for referral work, shown in Kaiser's letter on
CF0458 - 061230, ref SDS 2 3X6K, and confirmed by UCSF correspondence on 070906
CF0459 - saying Kaiser made the referral. ref SDS 5 UK5M
Charity Referral Loan Home Equity Collection Billings Erroneous Char
DA0401 - ..
DA0402 - UCSF Offers Payment Assistance to Patient Rather than Kaiser
DA0404 - Follow up ref SDS 4 9K7G
DA0406 - UCSF letter continues...
DA0408 - 3. As I mentioned earlier to Rod, we can arrange for interest free
DA0409 - payment plans for Ms Buck if she so requests. We also have a
DA0410 - Charity Care program, to assist patients with low income.
DA0411 - ref DRT 1 9J6L
DA0413 - ..
DA0414 - On 070830 UCSF proposals for payment assistance and charity for Millie
DA0415 - were misdirected, since there is no evidence the patient owes UCSF
DA0416 - money, and evidence shows Kaiser is liable for costs of care for
DA0417 - Millie contracted on referral to UCSF, and therefore collection
DA0418 - efforts should be applied to assist Kaiser in making timely payment to
DA0419 - UCSF. ref SDS 4 9K8Q
DA0421 - ..
DA0422 - UCSF letter continues...
DA0424 - 4. Here is a listing of the accounts with current patient
DA0425 - responsibility. There are other accounts not listed here that
DA0426 - we are awaiting insurance payment. ref DRT 1 SK7G
DA0428 - ..
DA0429 - 12593370 O BUCK ,MILDRED 03/01/07 01/21/1936 $ 202.65
DA0430 - 12763636 O BUCK ,MILDRED 04/05/07 01/21/1936 $ 162.12
DA0431 - 12764302 O BUCK ,MILDRED 05/03/07 01/21/1936 $ 283.96
DA0432 - 12997805 O BUCK ,MILDRED 07/19/07 01/21/1936 $ 27.88
DA0433 - 12997886 O BUCK ,MILDRED 06/07/07 01/21/1936 $ 162.12
DA0434 - 12997900 O BUCK ,MILDRED 07/05/07 01/21/1936 $ 173.39
DA0436 - ..
DA0437 - This follows up Bob's last submission dated 070912, and received on
DA0438 - 070917. ref SDS 7 WP5I Review on 071006 shows pending issues of
DA0439 - justification have not been answered by UCSF. ref SDS 11 454M
DA0441 - ..
DA0442 - On 071006 Millie received additional billings that appear to duplicate
DA0443 - prior charges shown in the listing today. ref SDS 11 PRWW
DA0445 - [On 071010 Millie proposed making interim payment,
DA0446 - ref SDS 13 UW5J, and requested that UCSF submit
DA0447 - explanations showing the basis of billings, and the total
DA0448 - amount owed todate. ref SDS 13 HZ9X