THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: November 12, 2009 12:29 PM Thursday; Rod Welch

Called Paula to discuss Millie's claims for insurance coverage.

1...Summary/Objective


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Followed up call on 090731, when Paula was investigating how Kaiser
040902 - can secure Millie's rights. ref SDS 6 BD5I
040904 -  ..
040905 - Background on Paula's support for Millie's claim is reported in case
040906 - study listed on 090727 1153. ref SDS 5 BD5I
040908 -  ..
040909 - This afternoon, discussed meeting this morning with Doctor Johnson,
040910 - who is treating Millie without regard to Kaiser's and Millie's claim
040911 - against UCSF, reported on 091112 0930, ref SDS 8 H54F
040913 -  ..
040920 -  ..
040921 - Explained Millie's entitlement presented in her letter to the medical
040922 - team this morning at 0732, which transmitted the agenda for meeting at
040923 - 0930, with Doctor Johnson at Kaiser, reported on 091112 0752,
040924 - ref SDS 7 L64X
040926 -  ..
040927 - Paula indicated that Kaiser's policy is to pay for 2nd opinions that
040928 - are implemented by Kaiser for patient care.
040930 -  ..
040931 - Paula read over the telephone a record prepared by Kaiser's Expedited
040932 - Claims Department, which purported to report on a telephone
040933 - conversation presenting Millie's claim for medical services.  There
040934 - were two calls with Expedited claims, initiated at Paula's request on
040935 - 090525...
040936 -
040937 -    1.  On 090520 1203 called Kaiser Expedited Claims in Oakland,
040938 -        ref SDS 3 4M9G, and talked to Pamela Powell, ref SDS 3 PQ8P,
040939 -        and presented Millie's claim to get treatment for standard of
040940 -        care in time to be effective recovering from her 8th relapse of
040941 -        cancer. ref SDS 3 9595
040943 -         ..
040944 -    2.  On 090521 0902 Pamela called back and said Expedited Claims
040945 -        cannot rule on Millie's request for support, because Millie's
040946 -        case falls through the cracks; Expedited claims cannot deny
040947 -        Millie's request for the doctor to prescribe treatment, but do
040948 -        not want to issue an order for a Kaiser doctor to prescribe
040949 -        care for a patient, and so Expedited Claims called Doctor
040950 -        Johnson to encourage resolution, and also submitted the case to
040951 -        Member Services in Pleasenton. ref SDS 4 UD5H
040953 -  ..
040954 - The narrative Paula read from Kaiser's report on conversations with
040955 - Expedited Claims seemed considerably different from understandings for
040956 - the call reported on 090520 1203, ref SDS 3 PQ8P, and for the follow
040957 - up call the next day on 090521 0902. ref SDS 4 X68I
040959 -  ..
040960 - Nothing that was actually stated in call with the Expedited Claims
040961 - Department was included in the record prepared by Expedited Claims, as
040962 - read by Paula from Kaiser's computer this afternoon, and nothing in
040963 - the report prepared by the Expedited Claims Department was actually
040964 - stated in the telephone call with Expedited claims.
040966 -  ..
040967 - Paula seemed to say, in the call today, that she has been told by
040968 - management that Kaiser does not want to demand performance from UCSF
040969 - on correcting medical mistakes, nor recover costs from UCSF for
040970 - defective work on Kaiser's referral for Millie to get radiation
040971 - medical services beginning on 090219 and to 090317.  She explained
040972 - that Kaiser has a good business relationship with UCSF, and Kaiser's
040973 - management feels this would be damaged by Kaiser demanding that UCSF
040974 - remedy injuries Millie suffered getting radiation medical services on
040975 - referral from Kaiser.  Paula feels Kaiser will never hold UCSF
040976 - responsible for medical mistakes in Millie's case.
040977 -
040978 -            [On 100606 2314 Kaiser steadfastly refuses communication
040979 -            with Kaiser to save the life of a patient shows Kaiser is
040980 -            not benefitting from a "good business relationship with
040981 -            UCSF. ref SDS 10 036C
040983 -             ..
040984 -            [On 100607 1021 Paula seems to revise understandings
040985 -            presented today, saying Kaiser does not object to demanding
040986 -            UCSF correct medical mistakes. ref SDS 11 QN4M
040988 -             ..
040989 -            [On 100607 1117 letter to Paula confirms new understanding
040990 -            today, that Kaiser does not object to demanding UCSF
040991 -            correct medical mistakes that occurred providing Millie's
040992 -            care on referral from Kaiser. ref SDS 12 R34P
040994 -             ..
040995 -            [On 100607 1117 letter to Paula notes that Kaiser can
040996 -            resolve Millie's claim by notifying UCSF to commence work
040997 -            within 10 days to repair Millie's injuires caused by UCSF
040998 -            medical mistakes, and if Kaiser fails to perform, then
040999 -            Kaiser will hire someone else and bill UCSF. ref SDS 12
041000 -            R34P
041002 -  ..
041003 - Therefore Kaiser has elected to provide treatment limited by Millie's
041004 - health insurance paid by Medicare, rather than provide necessary and
041005 - reasonable care to recover from medical mistakes, and obtain payment
041006 - from UCSF.
041008 -             ..
041009 -            [On 100528 0322 Millie requested Medicare support for
041010 -            quality care, and conformance with entitlement to recover
041011 -            from medical mistakes getting radiation treation on
041012 -            referral from Kaiser, ref SDS 9 QQ6N; asked Medicare to
041013 -            hold Kaiser accountable for Millie's care because desire to
041014 -            have good business relationship with UCSF does not excuse
041015 -            failure to provide effective care. ref SDS 9 QZ5U
041017 -  ..
041018 - Paula proposed that Millie ask UCSF for recovery of damages from
041019 - defective medical services, rather than claim recovery from Kaiser,
041020 - and demand that Kaiser recover damages from UCSF.  She feels there is
041021 - nobody at Kaiser who will exercise Kaiser's responsibility to Millie
041022 - for recovering from UCSF's defective work providing radiation medical
041023 - services ordered and paid on referral by Kaiser.
041025 -  ..
041026 - Paula is not sure what to do in this case.
041028 -  ..
041029 - She asked how Millie is doing?
041031 -  ..
041032 - Explained not well.  Chemotherapy is not working, which everydoby knew
041033 - before UCSF proposed it in July.  She is very tired and weak from side
041034 - effects, staying in bed most of the time from pills to suppress pain,
041035 - reported in Millie's letter to the team this morning, reported on
041036 - 091112 0752, ref SDS 7 L65W, and discussed with Doctor Johnson at
041037 - Kaiser in a meeting this morning finding Millie's cancer is getting
041038 - worse, and so her treatment must be changed again. ref SDS 8 H54F
041040 -  ..
041041 - Paula plans to inquire further.
041042 -
041043 -
041044 -
041045 -
041046 -
041047 -
041048 -
041049 -
041050 -
041051 -
0411 -