THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: November 28, 2007 12:01 PM Wednesday;
Kaiser appeals committee approved payment for Millie's care at UCSF.
2...Kaiser Approved Payment for Millie's Treatment on Referral to UCSF
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Kaiser Agrees Pay Millie's Treatment Clinical Trials on Referral to
A703 - ..
A704 - Summary/Objective
A70501 - Follow up ref SDS 65 0000. ref SDS 62 0000.
A70509 - ..
A708 - Discussion
A70901 - Kaiser Approved Payment for Millie's Treatment on Referral to UCSF
A70903 - Follow up ref SDS 65 TH8L, ref SDS 62 TH8L.
A70905 - Paula called and reported that the Appeals Committee met yesterday in
A70906 - Oakland, as planned on 071126. ref SDS 65 H75W Kaiser approved
A70907 - payment for Millie's care on referral to UCSF, as discussed with Paula
A70908 - originally when she called on 071006. ref SDS 37 0001
A70910 - [On 071204 1517 received letter from Paula confirming that
A70911 - Kaiser will pay for Millie's treatment at UCSF on referral from
A70912 - Kaiser to recover from 4th relapse of cancer. ref SDS 69 TH8L
A70965 - ..
A70966 - Kaiser's approval today implements...
A70968 - 1. Agreement between Kaiser and UCSF on 061230 that Kaiser would
A70969 - pay any costs for Millie's care not covered by the clinical
A70970 - trial. ref SDS 9 3X6K
A70972 - 2. Doctor prescribed treatment in a clincial trial and told the
A70973 - patient on 070105 that care would be performed on referral at
A70974 - UCSF. ref SDS 10 PK68
A70976 - ..
A70977 - 3. Authorization for Millie's treatment on referral to UCSF was
A70978 - submitted by the doctor on 070119. ref SDS 12 4R4M
A70980 - ..
A70981 - 4. Doctor Rugo's notice on 070130 that Millie would not get stuck
A70982 - with a big bill from UCSF. ref SDS 13 LY9H
A70984 - ..
A70985 - 5. Primary care physician notice on 071116 advised that Kaiser
A70986 - re-submitted authorization for Millie's treatment in a clinical
A70987 - trial on referral to UCSF. ref SDS 64 J65H, and reported to
A70988 - Paula on 071126. ref SDS 65 H74U
A70990 - ..
A70991 - Kaiser's approval today sustains 4 objectives in case management set
A70992 - on 070830...
A70994 - 1. Kaiser retains responsiblity for Millie's care. ref SDS 26
A70995 - T94O
A70997 - 2. Patients can rely on the doctor. ref SDS 26 Q56F
A70999 - ..
A71000 - 3. Kaiser manages complex billings, ref SDS 26 RV6F, rather
A71001 - than the patient being "cut loose" to fend for herself,
A71002 - reviewed on 070927. ref SDS 33 T78J
A71004 - ..
A71005 - 4. Kaiser responsibile for implementing Medicare regulations.
A71006 - ref SDS 26 RV6M
A71008 - ..
A71009 - Case study needed to assess implications for 16 issues listed on
A71010 - 070927. ref SDS 33 WU6M This would address lack of knowledge reported
A71011 - at UCSF on 070906, ref SDS 28 I49K, and at Kaiser reported on 070907.
A71012 - ref SDS 30 XH5H
A71014 - ..
A71015 - A big improvement Kaiser can make for Senior Advantage Medicare
A71016 - patients would be to provide classes for orientation on how care will
A71017 - differ from prior coverage, illustrated by the record on 070830
A71018 - meeting at UCSF. ref SDS 26 LQ5I
A71020 - ..
A71021 - Another improvement would be for Kaiser to perform case management and
A71022 - administration to determine the amount of charges in advance of
A71023 - treatment so that patients can make rational choices, as implied by
A71024 - Kaiser's policy statments reviewed on 070824. ref SDS 25 SF52
A71026 - ..
A71027 - Thanked Paula for excellent work assembling the record presented to
A71028 - the Appeals Committee, discussed on 071126. ref SDS 65 TH8L
A71030 - [On 071128 planning for letter to Kaiser on evaluating SDS
A71031 - support for case management in health care. ref SDS 66 TH8L
A71033 - [On 071202 submitted letter thanking Paula for support
A71034 - correcting case management problems and explaining role of SDS.
A71035 - ref SDS 67 FC5M
A71037 - ..
A71038 - [On 071203 0926 Paula feels SDS was helpful to Kaiser resolving
A71039 - case management problems for Millie's treatment on referral to
A71040 - UCSF. ref SDS 68 TH8L
A71042 - ..
A71043 - Paula will call to notify UCSF that Kaiser will pay for Millie's
A71044 - treatment, as called out in EOC section 2, reviewed on 070921,
A71045 - ref SDS 33 WS6M; and, that UCSF can therefore stop sending notices
A71046 - that Millie's treatment will be terminated because Kaiser has failed
A71047 - to make payments, reported recently on 071031. ref SDS 59 KM4J
A71049 - ..
A71050 - Paula said Millie will receive another form letter from MCRC to
A71051 - confirm results of the determination in this case, and likely similar
A71052 - to the letter dated 071006 received on 071010 that had a lot of
A71053 - mistakes. ref SDS 42 TH8L