CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 42 0000. ref SDS 41 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060508 -
060510 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Kaiser Used 071002 Letter to CMS to Construct Millie's Appeal
060902 -
060903 - Follow up ref SDS 42 TH8L, ref SDS 41 TH8L.
060904 -
060906 -  ..
060907 - Millie received in the mail today two new documents from UCSF...
060908 -
060909 -    1.  UCSF Medical Center
060910 -        Patient Financial Services
060911 -        Box 0810
060912 -        San Francisco, Ca  94145-0810
060914 -         ..
060915 -        October 26, 2007
060917 -         ..
060922 -         ..
060923 -    2.  Subject:  Collection Agency Referral Final Notice
060924 -                  Account # 12593370
060926 -                  Service Dt:  March 1, 2007
060927 -                  Balance Due:  $202.65
060929 -         ..
060930 -    3.  Final Notice *** Final Notice *** Final Notice***
060932 -         ..
060933 -        Payment for the above service date has not been received.
060934 -        Your account has been scheduled for assignment to a Collection
060935 -        Agency, which will affect your credit rating.
060937 -  ..
060938 - On 070830 UCSF explained practice of referring claims for payment to
060939 - collection agencies. ref SDS 14 9K7G  Action today implements that
060940 - solution and seems unjustified to resolve payment dispute with Kaiser
060941 - in light of UCSF documentation showing Kaiser is liable for payment in
060942 - this case, listed on 070830 and explained to UCSF at that time.
060943 - ref SDS 14 T247
060944 -
060945 -            [On 071105 Kaiser reports UCSF has not submitted billing
060946 -            information; copy of letter reminds UCSF to submit billing
060947 -            charges for prompt payment by Kaiser. ref SDS 43 K37X
060949 -             ..
060950 -            [On 071105 Kaiser notified UCSF plans collection actions to
060951 -            recovery payment of $202.65. ref SDS 43 K39X
060953 -             ..
060954 -            [On 071128 Kaiser Appeals Committee approved payment for
060955 -            Millie's care on referral to UCSF. ref SDS 44 JZ5R
060957 -  ..
060958 - The amount of UCSF invoice 12593370 has been a moving target, reported
060959 - to UCSF on 071027. ref SDS 39 MA8S
060961 -  ..
060962 - Invoice 12593370 initially was submitted on 070410.  At that time,
060963 - UCSF reported the patient owed zero, i.e., nothing -- $0.00, shown on
060964 - 070830. ref SDS 14 M55J  The patient concurrd pursuant to agreement
060965 - between UCSF and Kaiser on 061230 for Kaiser to pay any costs not
060966 - covered by the clinical trial. ref SDS 7 3X6K  The same invoice was
060967 - later submitted with a revised date of 070810, and UCSF revised the
060968 - amount owed to $202.65, but was not attributed to any service
060969 - performed by UCSF. (reported on 070830). ref SDS 14 M55J
060971 -  ..
060972 - UCSF re-submitted invoice # 12593370 again during a meeting on 070830.
060973 - ref SDS 14 4P8K  At that time, UCSF claimed recovery for invoice
060974 - #12593370 in the amount of $1,240.96. ref SDS 14 MF4Q  Included in
060975 - this amount was a line item...
060976 -
060977 -    060407 1 0101005 DENIED CO-INSURANCE            202.65    202.65             202.65
060978 -
060979 - ...there is another line item of $1,240.96 indicating UCSF actually
060980 - seeks recovery of $2,481 92. ref SDS 14 4P6F
060982 -  ..
060983 - Most recently, on 070917 Millie received from UCSF another revision
060984 - of invoice 12593370 with a letter dated 070912. ref SDS 18 595P  UCSF
060985 - reduced the amount claimed for recovery on invoice #12593370 back to
060986 - $202.65. ref SDS 18 MK4H
060988 -  ..
060989 - UCSF sent a letter on 071028 requesting payment for coinsurance on 5
060990 - invoices totalling about $1,300. ref SDS 36 SU4Q  Why does notice of
060991 - collection agency action only pertain to one of these claims?
060993 -  ..
060994 - On 071024 Millie proposed a meeting, ref SDS 33 EP6S, for UCSF to
060995 - explain the basis of confusing charges, ref SDS 33 EP5T, including a
060996 - spreadsheet showing the total of UCSF claims, following up her letter
060997 - on 071011. ref SDS 29 K64Q
060999 -  ..
061000 - Millie's letter on 071027 propsed meeting again. ref SDS 39 CG6H
061002 -  ..
061003 - UCSF refusal to meet and explain floating charges suggests resistance
061004 - to transparency and accountability essential to resolve evident
061005 - billing irregularities listed on 071026. ref SDS 36 X18J
061007 -  ..
061008 - UCSF collection efforts on behalf of Kaiser presents a conflict of
061009 - interest, where UCSF knows or reasonably should know that Kaiser is
061010 - responsible for payment, reported during the meeting on 070830,
061011 - ref SDS 14 T14K, and explained again to UCSF in a letter on 071027.
061012 - ref SDS 39 MA6Q
061014 -  ..
061015 - What action has UCSF taken to collect $202.65 from Kaiser?  Shouldn't
061016 - threats of assigning Collection Agency efforts and credit rating
061017 - impairment be first directed to Kaiser?
061019 -  ..
061020 - UCSF collection agency letter continues...
061021 -
061022 -    4.  To avoid this action we need payment in full.  If you cannot
061023 -        make payment infull, you must contact us within 10 days.
061025 -  ..
061026 - The question is not whether payment can be made, but whether payment
061027 - is owed and, if so, how much?
061029 -  ..
061030 - Need to figure out what to do with UCSF notice, so that additional
061031 - mistakes are not made that compound damages caused by improper billing
061032 - to the patient, and Kaiser failure to perform payment requirements.
061034 -  ..
061035 - Does UCSF letter on 071030, ref SDS 41 CP7K, withdraw notices received
061036 - today, but dated 071026, ref SDS 0 P753, and 071027, per below?
061037 - ref SDS 0 KM8J
061039 -  ..
061040 - UCSF collection agency letter continues...
061041 -
061042 -        Thank you.
061043 -
061044 -
061046 -         ..
061047 -        Patient Accounting
061048 -        415 673 1113
061050 -         ..
061051 -    5.  If you wish to pay by credit card, complete the below
061052 -        information and return the bottom portion to us promptly.
061053 -
061055 -         ..
061056 -    6.  Patient Account #:   12593370
061058 -         ..
061061 -         ..
061062 -        Credit Card #             Exp Date            Amount $
061064 -         ..
061065 -        Type (Circle one):   Mastercard   Visa   AMX    Discover
061067 -         ..
061068 -        Name on card
061070 -         ..
061071 -        Signature
061073 -         ..
061074 -    7.  Please make return address on back page shows through the
061075 -        window of return envelope provided.
061077 -         ..
061078 -    8.  Please Return to:
061080 -         ..
061081 -        UCSF Medical Center
061082 -        C/O Wells Fargo Bank
061083 -        Department 3-9157
061084 -        PO Box 39000
061085 -        San Francisco, CA  94139 8157
061086 -
061087 -
061089 -  ..
061090 - Termination Treatment Threatened Pending Payment $202.65
061091 -
061093 -  ..
061094 - Millie received a second letter dated 071027, supplementing the letter
061095 - dated 071026 threatening collection actions, per above, ref SDS 0
061096 - TH8L, and saying termination of treatment is at risk...
061097 -
061098 -    1.  UCSF Medical Center
061099 -        Patient Financial Services
061100 -        Box 0810
061101 -        San Francisco, Ca  94145-0810
061103 -         ..
061104 -        October 27, 2007
061106 -         ..
061111 -         ..
061112 -    2.  Subject:  Possible Termination Non-emergency Medical Services
061113 -                  on Referral from Kaiser
061114 -                  Account # 12593370
061116 -                  Service Dt:  March 1, 2007
061117 -                  Balance Due:  $202.65
061119 -         ..
061120 -    3.  Our records indicate that you have received Health Care
061121 -        Services at UCSF Medical Center.  Your payment for these
061122 -        services not been received.
061124 -  ..
061125 - UCSF records are incorrect.
061127 -  ..
061128 - There is no evidence Millie owes payment of $202.65 nor of any amount
061129 - to UCSF for health care services, since costs of her treatment are
061130 - pyable by Kaiser, as agreed between Kaiesr and UCSF in correspondence
061131 - on 061230. ref SDS 7 3X6K  UCSF has performed medical services to
061132 - treat Millie at all times knowing Kaiser is liable for all costs of
061133 - care.
061135 -  ..
061136 - UCSF was notified on 061230 that Kaiser would pay any costs for
061137 - treatment on referral from Kaiser and not covered by a clinical trial.
061138 - ref SDS 7 3X6K  On 070906 Doctor Rugo reported that Kaiser made the
061139 - referral. ref SDS 16 UK5M  Recently, on 071030 Paula reported her
061140 - investigation discovred that Kaiser made the referral. ref SDS 41 FM6H
061141 - Accordingly, any payment owed for medical services are owed by Kaiser
061142 - and not the patient.
061144 -  ..
061145 - UCSF treatment cancellation letter continues...
061146 -
061147 -    4.  Unless you pay your account in full or make acceptable
061148 -        financial arrangements with our Patient Accounting Department,
061149 -        you will no long be able to receive non-emergency medical
061150 -        services from our hospital or clinics.
061152 -  ..
061153 - Has UCSF notified Kaiser about requirement for payment of $202.65 to
061154 - avoid terminating treatment ordered by Kaiser on 061230, and confirmed
061155 - on 070119? ref SDS 9 4R4M  Has Kaiser approved UCSF terminating
061156 - referral treatment?
061157 -
061158 -            [On 071105 Kaiser reports UCSF has not submitted billing
061159 -            information; copy of letter reminds UCSF to submit billing
061160 -            charges for prompt payment by Kaiser. ref SDS 43 K37X
061162 -             ..
061163 -            [On 071105 Kaiser notified UCSF plans collection actions to
061164 -            recover payment of $202.65. ref SDS 43 K39X
061166 -             ..
061167 -            [On 071128 Kaiser Appeals Committee approved payment for
061168 -            Millie's care on referral to UCSF. ref SDS 44 JZ5R
061170 -  ..
061171 - Has UCSF notified Kaiser that failure to pay $202.65 for medical
061172 - services places their referral patient in peril?
061174 -  ..
061175 - Kaiser indicated during a meeting on 070921 that continuing Millie's
061176 - treatment with cetuximab, which has proved very effective at UCSF,
061177 - would be much more expensive at Kaiser. ref SDS 19 CU58
061179 -  ..
061180 - Does UCSF letter on 071030, ref SDS 41 CP7K, withdraw notices received
061181 - today, but dated 071026, per above, ref SDS 0 P753, and 071027?
061182 - ref SDS 0 KM8J
061184 -  ..
061185 - Billing irregularities in this case are listed on 071026. ref SDS 36
061186 - X18J
061188 -  ..
061189 - UCSF has a duty to take notice of the doctor's referral for care on
061190 - 061230, and UCSF acting on that referral noted by UCSF letter on
061191 - 070906. ref SDS 16 UK5M  UCSF now places the patient in extreme
061192 - jeapordy by refusal to perform, and threatening refusal to perform,
061193 - simply because of payment dispute with Kaiser.  Kaiser's duty to pay
061194 - for referral of medically prescribed treatment is independent of any
061195 - paper Kaiser does or does not issue to UCSF.
061197 -  ..
061198 - UCSF at all times knows or resonably should know Kaiser is capable of
061199 - paying the amount of UCSF's claim of $202.65, plus reasonable and
061200 - necessary costs of collection, and so has no exposure to loss that
061201 - would justify ending patient treatments to avoid financial loss.
061202 -
061210 -  ..
061211 - UCSF treatment cancellation letter continues...
061212 -
061213 -    5.  If you have any questions about his notice or wish to make
061214 -        financial arrangments, please contact us.
061216 -         ..
061217 -        Sincerely,
061218 -
061219 -
061221 -         ..
061222 -        Patient Accounting
061223 -        415 673 1113
061224 -
061225 -
061227 -         ..
061228 -    6.  If you wish to pay by credit card, complete the below
061229 -        information and return the bottom portion to us promptly.
061230 -
061232 -         ..
061233 -    7.  Patient Account #:   12593370
061234 -
061237 -         ..
061238 -        Credit Card #             Exp Date            Amount $
061240 -         ..
061241 -        Type (Circle one):   Mastercard   Visa   AMX    Discover
061243 -         ..
061244 -        Name on card
061246 -         ..
061247 -        Signature
061249 -         ..
061250 -    8.  Please make return address on back page shows through the
061251 -        window of return envelope provided.
061253 -         ..
061254 -    9.  Please Return to:
061255 -
061256 -        UCSF Medical Center
061257 -        C/O Wells Fargo Bank
061258 -        Department 3-9157
061259 -        PO Box 39000
061260 -        San Francisco, CA  94139 8157
061261 -
061262 -
061263 -
061264 -
061265 -
061266 -
061267 -
061268 -
061269 -
061270 -
061271 -
0613 -