CONTACTS 

SUBJECTS
Kaiser Payment Millie's Treatment  Cntinuing Care Referral UCSF Clin

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 23 0000, ref SDS 22 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Called a bunch of lawyers today, including the Contra Costa Lawyers
040902 - Referral Service to research experience working with Kaiser's MCRC
040903 - Appeasl Committee based on the letter from Paula received on 071010.
040904 - ref SDS 23 R16K
040906 -  ..
040907 - Nobody seems to be litigating Kaiser Senior Advantage Medicare
040908 - insurance coverage issues.
040910 -  ..
040911 - Geoffrey White in San Francisco..... 415 362 5658
040912 -
040913 -        Geoffrey V. White, Esq
040914 -        351 California St #1500
040915 -        San Francisco, CA  94194
040916 -        415 362 4548
040918 -               ..
040919 -              http://www.google.com/search?hl=en&q=Geoffrey+White+lawyer+San+Francisco
040921 -  ..
040922 - Practice is listed as....
040923 -
040924 -        civil rights
040925 -        employment and labor law
040927 -  ..
040928 - Geoffrey has practiced in health insurance law.  He asked about the
040929 - case.
040931 -  ..
040932 - Millie's case arises from UCSF claim against Millie to recover costs
040933 - of "coinsurance" for treatment in clinical trial.  Background is
040934 - reported in the record meeting with UCSF on 070830. ref SDS 12 T14M as
040935 - set out in UCSF letter on 070912, reveiwed on 070917. ref SDS 15 596Q
040936 - UCSF relies on CMS section 69.9. ref SDS 15 4P4I
040938 -  ..
040939 - The dispute is actually with Kaiser who made the referral and agreed
040940 - in correspondence on 061230 to pay any costs not covered by the
040941 - clinical trial. ref SDS 5 3X6K  UCSF explained Kaiser's refusal to pay
040942 - for referral on 070830. ref SDS 12 NQ3F
040944 -  ..
040945 - Kaiser claims that despite having made referral, Kaiser avoids paying
040946 - for clinical trial services, because Medicare law conveys a benefit
040947 - that patients can "self-refer" without authorization of the doctor to
040948 - particiapte in clinical trials for advancing medical science that
040949 - improves treatements.  In that case, Medicare pays for 80% of costs,
040950 - and patients are liable for 20%.
040952 -  ..
040953 - Millie did not self-refer.  Kaiser prescribed treatment on referral to
040954 - UCSF on 070105, ref SDS 6 PK68, in performing Kaiser's duty to provide
040955 - standard of care for oncology practice explained earlier on 040318,
040956 - ref SDS 3 PU6M, and not withstanding provision in Evidence of Coverage
040957 - (EOC) received OA 070101 that says patients have to pay for
040958 - coinsurance, reviewed on 070927. ref SDS 18 1F92
040960 -  ..
040961 - Kaiser submitted guidance on 070829 that says patients "may" incur
040962 - conisurance expense, which leaves open that Kaiesr can prescribe
040963 - treatment on referral. ref SDS 11 RA85
040965 -  ..
040966 - Statutory authorty in Title IV part 419.40 discusses coinsurance,
040967 - reviewed on 070917. ref SDS 15 4Q3I
040969 -  ..
040970 - We need to find legal authority (presumably within Title IV) that
040971 - conveys benefits to Medicare patients for "self-referral," in oder to
040972 - assess whether this precludes Kaiser, as an HMO service provider under
040973 - Senior Advantage, from prescribing treatment on referral, i.e., are
040974 - doctor referrals per se patient self-referrals, per question to CMS on
040975 - 071002? ref SDS 19 OY4Q
040977 -  ..
040978 - Millie wants to continue treatment at UCSF, and has four (4) concerns
040979 - about agreeing to pay coinsurance, apart from cost, listed on 070830.
040980 - ref SDS 12 T94H  This was confirmed in a letter to UCSF on 070924.
040981 - ref SDS 17 UL5R
040982 -
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0410 -