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SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0000, ref SDS 7 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Pamela said she consulted with 2 doctors about Millie's claim
040902 - presented yesterday to the Expedited Claims Department, as shown in
040903 - the record on 090520 1203. ref SDS 9 9595
040905 -  ..
040906 - Pamela further advised that Expedited Claims feels Millie's case
040907 - "falls through the cracks" at Kaiser, and so the Expedited Claims
040908 - Department cannot deny Millie's demand that Kaiser provide treatment
040909 - for standard of care recovering from Millie's 8th relapse of cancer.
040911 -  ..
040912 - Previously, Doctor Johnson tried to improve communication so that
040913 - Millie's care would not "fall through the cracks" at Kaiser, reported
040914 - on 090205 1318. ref SDS 3 278T
040916 -  ..
040917 - Pamela explained today that most cases received by Expedited Claims
040918 - are patients requesting Kaiser to make a referral, including Medicare
040919 - patients requesting referral for clincial trials.  Since Millie is
040920 - asking Kaiser to perform requirements of EOC Section 2 in the
040921 - insurance agreement, reviewed on 070927 1311. ref SDS 1 WS6M, which
040922 - requires a workup to evaluate major change in patient profile, get
040923 - advice from the Tumor Board, analyse trade-offs of possible
040924 - treatments, and prescribe care in time to be effective, as filed in
040925 - Millie's case, reported on 090520 1203. ref SDS 9 9595, Pamela this
040926 - falls outside the experience of the Expedited Claims Department.
040928 -  ..
040929 - Pamela said that Expedited Claims deos not want to direct Millie's
040930 - doctor to provide standard of care, and further feels that Millie's
040931 - claim for standard of care listed on 090520, ref SDS 9 9595, cannot be
040932 - denied.  Therefore, the Expedited Claims Department has resolved the
040933 - dilemma by sending Millie's claim to the Claims Resolution Department
040934 - in Pleasanton.
040936 -  ..
040937 - This accomplishes Paula's work plan for expediting Millie's care,
040938 - discussed in her call yesterday on 090520 1153, ref SDS 8 T65H
040939 -
040940 -            [On 090521 2006 Millie received a letter from Doctor
040941 -            Johnson saying Millie can choose which next treatment
040942 -            regimen that Millie wants, and that no treatment would
040943 -            be considered more superior than another, ref SDS 12
040944 -            UD5H; the doctor says Millie needs urgent treatment and
040945 -            so should notify Kaiser which treatment Millie chooses
040946 -            by the end of the week, which is the next day in roughly
040947 -            12 hours. ref SDS 12 HC8O; the doctor further tells
040948 -            Millie to call Medicare for prescribing appropriate
040949 -            treatment. ref SDS 12 HC93
040951 -             ..
040952 -            [On 090523 0148 Millie sent a letter to Paula with Kaiser
040953 -            Member Services Claims Resolution Department, ref SDS 13
040954 -            2P6J, requesting a determination of her claim to
040955 -            entitlement for medical services under EOC section 2 of the
040956 -            insurance agreement with Kaiser. ref SDS 13 DQ5S
040958 -             ..
040959 -            [On 090528 0803 Kaiser has not responded; called and talked
040960 -            to Paula; she sent this letter today demanding care for
040961 -            cancer to Kaiser's Expedited Claims Department, ref SDS 14
040962 -            PP6Q, which has already reviewed the matter an advised that
040963 -            Expedited Claims sent Millie's case to Paula's Department
040964 -            in Kaiser Member Services Claims Resolution, reported on
040965 -            090521 0902. ref SDS 11 RW82
040967 -             ..
040968 -            [On 090528 1228 Millie notifies Paula in Member Services
040969 -            Claims Resolution objects to delaying treatment caused by
040970 -            errors referring treatment back and forth between
040971 -            Departments. ref SDS 15 4M6Y
040973 -             ..
040974 -            [On 090727 2012 sent letter to Paula explaining Millie's
040975 -            entitlement to recover damages including expanded treatment
040976 -            to recover from UCSF's medical mistake. ref SDS 16 3S4I
040978 -             ..
040979 -            [On 090730 1129 Paula in Kaiser Claims Resolution
040980 -            Department corridinating to get relief at Kaiser for
040981 -            Millie's injuries caused by UCSF medical mistakes providing
040982 -            radiation treatment on referral from Kaiser. ref SDS 17
040983 -            BD5I
040985 -  ..
040986 - Pamela said that either she or one of the two doctors who reviewed
040987 - Millie's case will call Doctor Johnson and suggested he call Millie
040988 - and try to work out a solution.  This aligns with Millie's several
040989 - letters to Doctor Johnson yesterday reporting to the doctor and to the
040990 - medical team that the doctor has been called at 3 or 4 times, and was
040991 - asked in the letters to call back, but has not done so, reported on
040992 - 090520 1710. ref SDS 10 ZF5R
040994 -  ..
040995 - Pamela said again that prescribing treatment is the doctor's
040996 - responsiblity, so Expedited Claims cannot deny Millie's request for
040997 - the doctor to prescribe care, as presented in the call yesterday on
040998 - 090520 1203. ref SDS 9 9595
041000 -  ..
041001 - This aligns with Paula's call yesterday, in Member Services Claims
041002 - Resolution, explaining that Kaiser requires the doctor to prescribe
041003 - treatment based on best evidence. ref SDS 8 4M9G
041005 -  ..
041006 - Emphasized that Millie does not complain against Doctor Johnson, but
041007 - rather commends his work, and requests that Kaiser assist Doctor
041008 - Mason, who has incorrectly told Doctor Johnson not to prescribe
041009 - Millie's care based on evidence showing the best course of treatment,
041010 - and that Doctor Mason's direction to Doctor Johnson conflicts with EOC
041011 - provisions, and application law to Millie's patient history.
041013 -  ..
041014 - Pamela said she expects Millie will get feedback from Kaiser within 5
041015 - days.  She said Kaiser gives priority to cancer patients, and that
041016 - Millie's patient profile suffering an 8th relapse requires immediate
041017 - care.
041019 -  ..
041020 - Thanked Pamela for investigation and efforts to expedite Millie's
041021 - care.
041022 -
041023 -            [On 090521 2006 Millie received a letter from Doctor
041024 -            Johnson saying Millie can choose which next treatment
041025 -            regimen that Millie wants, and that no treatment would
041026 -            be considered more superior than another, ref SDS 12
041027 -            UD5H; the doctor says Millie needs urgent treatment and
041028 -            so should notify Kaiser which treatment Millie chooses
041029 -            by the end of the week, which is the next day in roughly
041030 -            12 hours. ref SDS 12 HC8O; the doctor further tells
041031 -            Millie to call Medicare for prescribing appropriate
041032 -            treatment. ref SDS 12 HC93
041034 -             ..
041035 -            [On 090523 0148 Millie sent a letter to Paula with Kaiser
041036 -            Member Services Claims Resolution Department, ref SDS 13
041037 -            2P6J, requesting a determination of her claim to
041038 -            entitlement for medical services under EOC section 2 of the
041039 -            insurance agreement with Kaiser. ref SDS 13 DQ5S
041041 -             ..
041042 -            [On 090528 0803 Kaiser has not responded; called and talked
041043 -            to Paula; she sent this letter today demanding care for
041044 -            cancer to Kaiser's Expedited Claims Department, ref SDS 14
041045 -            PP6Q, which has already reviewed the matter an advised that
041046 -            Expedited Claims sent Millie's case to Paula's Department
041047 -            in Kaiser Member Services Claims Resolution, reported on
041048 -            090521 0902. ref SDS 11 RW82
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