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: June 9, 2010 03:22 PM Wednesday;
Rod Welch
Jennifer called for help processing Millie's claim at Kaiser.
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 ref SDS 43 0000. ref SDS 42 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 010427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks
040902 - so good nobody can believe she has such severe cancer, ref SDS 13
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through
040904 - 11 relapses to resist chemotherapy. The doctor advised that Kaiser
040905 - has a new strategy prescribing therapy that is effective for treating
040906 - cancer as a chronic disease by "targeting" the genetic profile of
040907 - cancer that has mutated in patients, like Millie, to resist
040908 - chemotherapy. ref SDS 13 SJ6N
040910 - ..
040911 - On 100501 1037 Millie letter to medical team confirms understanding of
040912 - new strategy to treat Millie's cancer with targeted therapy.
040913 - ref SDS 14 F25O
040915 - ..
040916 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040917 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040918 - of cancer caused by UCSF medical mistakes. ref SDS 15 HH4I
040920 - ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 16 YX8L Kaiser contends that all of the
040923 - strategies for "targeted" therapies have been executed for Millie,
040924 - which seems conflicting with the record in this case. ref SDS 16 MZ4N
040926 - ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 17 TD5W
040930 - ..
040931 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040932 - with Abraxane chemotherapy that seems to be failing, and then after 3
040933 - more weeks without treatment, following a trip abroad, the doctor will
040934 - discuss "next steps." ref SDS 18 YL5N
040936 - ..
040937 - On 100503 2338 Millie reports to medical team that she will implement
040938 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040939 - letter on 010503, as assurance that recovery will be equal to changing
040940 - treatment immediately on 100505. ref SDS 19 6X7S
040942 - ..
040943 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040944 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040945 - communicate with Doctor Johnson, or had already done so, to coordinate
040946 - with Kaiser on planning Millie's next treatment to recover from the
040947 - 11th relapse of cancer. ref SDS 20 NT5N
040949 - ..
040950 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040951 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040952 - ref SDS 21 KE4K
040954 - ..
040955 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040956 - seemingly on an accelerating rise, which threatens to cascade out of
040957 - control, because Abraxane chemotherapy is not effective. ref SDS 22
040958 - L54I
040960 - ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 23 KE4K
040964 - ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 24 PK9O
040967 - ..
040968 - On 100527 0217 Millie files claim with Kaiser Claims Resolution
040969 - Department for standard of care to recover from 11th relapse of cancer
040970 - caused by medical mistakes getting radiation treatments at UCSF on
040971 - referral from Kaiser. ref SDS 25 IZ7N
040973 - ..
040974 - On 100528 0322 Millie requests support from Medicare to separate
040975 - recovery for medical mistakes getting radiation from UCSF, from health
040976 - care benefits limited by Medicare insurance coverage. ref SDS 26 QQ6N
040978 - ..
040979 - On 100528 1031 called Medicare they have formed a team to review
040980 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040981 - response to Millie's claim. ref SDS 27 4W5F
040983 - ..
040984 - 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040985 - collaborate with UCSF on treatment for Millie to recover from UCSF
040986 - medical mistakes. He discussed treating Millie with MPA, but this was
040987 - not prescribed because Millie was treated with MPA in 2009, and UCSF
040988 - ended the treatment due to fears about blood clot side effects, which
040989 - were believed to cause breathing problems Millie had, though later
040990 - breathing problems were discovered to be caused by defective radiation
040991 - treatment. Since Doctor Johnson said Kaiser has no more treatments
040992 - for Millie, the only way Millie can get relief from pain caused by
040993 - cancer that is progressing without treatment is get treatment in
040994 - Hospice. Since Hospice is the only choice of care offered today,
040995 - Millie accepted this.
040997 - ..
040998 - On 100601 1531 Sharon called to schedule starting Hospice medical
040999 - services beginning tomorrow between 0900 - 1000. ref SDS 14 036C
041001 - ..
041002 - On 100602 0913 Liz provides orientation on Hospice care; she confirms
041003 - Sharon's report yesterday, that if Kaiser performs on the insurance
041004 - agreement to provide standard of care for Millie's patient profile,
041005 - than Millie can elect to recover from 11th relapse of cancer, rather
041006 - than continue with Hospice support for dying peacefully. ref SDS 15
041007 - 036C
041009 - ..
041010 - On 100602 1046 Diane received notice from Medicare to file claim for
041011 - Millie to get treatment for recovering from UCSF medical mistakes; she
041012 - is preparing a statement of claim. ref SDS 32 036C Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 32 MZ5H Eileen called later and reported that Kaiser denied
041015 - Millie's claim on the grounds that Medicare does not authorize payment
041016 - for treatment to recover from cancer, after a patient starts Hospice.
041017 - ref SDS 32 UN4M Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 32 I33H Eileen called back after
041019 - reading the claim and advised the denial of claim has been withdrawn,
041020 - and the matter is referred to Claims Resolution Department.
041021 - ref SDS 32 UN5P
041023 - ..
041024 - On 100603 0449 Millie notified medical team that Kaiser called today
041025 - about moving forward to resolve medical mistakes getting radiation
041026 - treatment at UCSF on referral from Kaiser. ref SDS 33 IX9Q
041028 - ..
041029 - On 100606 1604 Doctor Johnson notifies Millie that her cancer marker
041030 - has remained fairly stable the past 3 weeks since ending treatment
041031 - with Abraxane on 100512; actually went up less without Abraxane, than
041032 - with it, because Millie's cancer resists chemotherapy. ref SDS 34 036C
041034 - ..
041035 - On 100606 1638 Millie thanks Doctor Johnson for submitting good news
041036 - cancer marker CA 15-3 606 much smaller rise than exptected after
041037 - ending treatment for 3 weeks. ref SDS 35 036C; asks if Doctor Rugo ever
041038 - returned Doctor Johnson's call from Kaiser, as planned in Doctor
041039 - Rugo's letter on 100501?
041041 - ..
041042 - On 100606 2317 Millie receives letter from Doctor Johnson reporting
041043 - that Doctor Rugo has never returned his call asking UCSF for Millie's
041044 - treatment plan, which demonstrates failure to perform on Doctor Rugo's
041045 - commitment in UCSF letter sent to the medical team on 100501.
041046 - ref SDS 36 036C
041048 - ..
041049 - On 100607 0932 called Cherry at Medicare about progress on contacting
041050 - Kaiser to process Millie's claim filed on 100527, and planned in the
041051 - call with Medicare (Cherry and Beth) as action item #8, planned the
041052 - next day on 100528 1031, ref SDS 27 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 37 036C
041055 - ..
041056 - On 100607 1021 called Paula at Kaiser - she said someone else is
041057 - handling Millie's claim, because the claim has not been denied, and
041058 - Paula only handles denied claims. ref SDS 38 036C; Paula further
041059 - reported that Kaiser no longer objects to demaning UCSF correct
041060 - medical mistakes, so Millie's claim should be easy to resolve.
041061 - ref SDS 38 QN9F
041063 - ..
041064 - On 100607 1117 letter to Paula confirming Kaiser's work plan to
041065 - process Millie's claim for care promptly in order to save her life.
041066 - ref SDS 39 036C
041068 - ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 40 036C Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 40 C354 Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 40 G84Q
041075 - ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 41 036C Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 41 8O4H Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 41
041080 - PRXY
041082 - ..
041083 - On 100609 1232 letter to CMS and Kaiser submitts agenda for conference
041084 - call to review progress on Kaiser resolving Millie's claim for
041085 - recovery from UCSF medical mistakes. ref SDS 42 036C
041087 - ..
041088 - On 100609 1300 CMS and Kaiser conference call to report progress on
041089 - reviewing Millie's claim for treatment to recover from UCSF medical
041090 - mistakes in time to be effective. ref SDS 43 036C
041092 - ..
041093 - On 100609 1522 Jennifer called for assistance processing Millie's
041094 - claim to recover from medical mistakes getting radiation treatment at
041095 - UCSF on referral from Kaiser. ref SDS 0 036C
041096 -
041097 -
041098 -
041100 - ..
0412 -
0413 -
0414 - Progress
0415 -
041501 - While hiking at Lafayette Reservoir, received call from Jenniver
041502 - located in Kaiser's Claims Resolution Department in Pleasanton, CA.
041504 - ..
041505 - Jennifer's call implements Irene's work plan in the conference call
041506 - with claim teams representing CMS and Kaiser, earlier today, reported
041507 - on 100609 1300. ref SDS 43 TO60
041508 -
041509 - [On 100610 0352 Millie's letter to Jennifer transmits
041510 - record of telecon today with Jennifer for confirming
041511 - understandings on issues to be determined by Kaiser
041512 - responding to Millie's claim. ref SDS 45 036C
041514 - ..
041515 - [On 100611 1521 Jennifer reported receiving Millie's
041516 - letter, ref SDS 48 FP5M, submitting the record of telecon
041517 - with Jennifer on 100609 1522. ref SDS 44 036C
041519 - ..
041520 - Jennifer has been assigned by Kaiser to process Millie's claim,
041521 - submitted to Paula on 100527 0217. ref SDS 25 IZ7N
041522 -
041526 - ..
041527 - During the call this afternoon, Jennifer presented Kaiser's
041528 - preliminary findings on Millie's request for medical services in her
041529 - claim submitted on 100527 0217. ref SDS 25 IZ7N Discussion clarified
041530 - following "issues" for Kaiser to determine...
041531 -
041532 - 1. Millie wants a claim determination that her injuries caused by
041533 - UCSF medical mistakes providing radiation treatment on referral
041534 - from Kaiser, have been compounded for the past year by delaying
041535 - her treatment since 090401, and by treating Millie at Kaiser
041536 - since July 2009, with chemotherapy requested by UCSF, and for
041537 - the purpose of limiting Millie's recovery to care paid by
041538 - Medicare benefits; whereas, Millie is entitled to and will be
041539 - provided necessary and reasonable care required to recover from
041540 - UCSF medical mistakes, as set out in Millie's claim, reported
041541 - on 100527 0217, ref SDS 25 X65Q
041543 - ..
041544 - It is for Kaiser and UCSF to work out the details of who pays
041545 - for Millie's injuries and recovery, so long as Millie is held
041546 - harmless of any and all expenses.
041547 -
041548 - [On 100611 2326 Millie received Jennifer's letter
041549 - confirming that Kaiser will respond, ref SDS 49 036C, to
041550 - 6-issues listed in the record of telecon on 100609,
041551 - ref SDS 0 XK50, and transmitted to the Kaiser and CMS
041552 - claim teams, and to Doctor Johnson and Doctor Rugo in
041553 - Millie's letter on 100610. ref SDS 45 DZ4X
041555 - ..
041556 - [On 100614 0257 Millie's letter to claim team confirmed
041557 - discussion today on Millie's right to choose Hospice based
041558 - on evidence of alternatives. ref SDS 50 SR8Y
041560 - ..
041561 - [On 100616 0832 Jennifer did not have time to call on
041562 - Tuesday, 100615; telecon the next day on 100616, indicated
041563 - Jennifer made progress on Millie's compensation issue to be
041564 - held harmless from UCSF medical mistakes, but she has been
041565 - unable to schedule treatment for Millie; she scheduled to
041566 - call on Friday, 100618, to report progress on Kaiser
041567 - prescribing treatment for Millie. ref SDS 51 PSSV
041569 - ..
041570 - [On 100618 0843 Jennifer did not call on Friday, and did
041571 - not return call asking about progress getting Millie a
041572 - prescription. ref SDS 52 036C
041574 - ..
041575 - 2. Millie wants her representative, Rod, to meet separately or
041576 - jointly with Doctor Johnson at Kaiser, and with Doctor Rugo,
041577 - and Doctor Hsu at UCSF, or their designees, to initially
041578 - explore patient history in conversation regarding the best
041579 - course of care based on clinical potential of available
041580 - options, including PARP, since this has never yet been done.
041582 - ..
041583 - Millie does not want to sit in an examination room and hear
041584 - detailed debate necessary to thoroughly explore her options.
041586 - ..
041587 - Millie wants a written medical opinion on chances of success
041588 - and some of the reasoning that supports such opinion. If
041589 - opinion concludes that PARP or nothing is likely to bring
041590 - recovery from 11th relapse of her cancer, Millie may say I want
041591 - to try PARP anyway or something else; or, she may decide to
041592 - stay in Hospice rather than suffer further emotional trauma of
041593 - false hope. If medical opinion concludes PARP is likely or
041594 - even very likely to be effective, Millie may say I don't feel
041595 - comfortable ending Hospice just to be disappointed again, or
041596 - she may say okay, I'll try PARP or equal.
041597 -
041598 - [On 100611 1521 Millie's claim requests standard of care
041599 - comparing trade-offs of alternate oncology care, including
041600 - Hospice, and only then can she justly be credited for
041601 - exercising her right to choose treatment for recovering
041602 - from UCSF medical mistakes, or choose Hospice. ref SDS 48
041603 - FQ5K
041605 - ..
041606 - 3. Jennifer asked if Millie wants to go back to UCSF for PARP
041607 - treatment?
041609 - ..
041610 - Millie requests remedies listed in the claim, ref SDS 25 X655,
041611 - which states in part that UCSF can treat Millie with PARP, or
041612 - hire others to do the work, and if UCSF fails, then Kaiser can
041613 - hire others and charge UCSF, reported on 100527 0217,
041614 - ref SDS 25 X74Q
041616 - ..
041617 - 4. Millie wants immediate presentation of PARP based on best
041618 - evidence of prognosis for recovering from 11th relapse of
041619 - cancer, and reserves the right to refuse treatment based on
041620 - evidence presented. If Millie agrees to resume treatment, then
041621 - she will go back to UCSF to mitigate damages, unless there is a
041622 - determination that UCSF has demonstrated ill-will or
041623 - incompetence that compromises chances of getting effective care
041624 - at UCSF. In the latter case, then Millie should get PARP at
041625 - another cancer center, or at Kaiser if that can be arranged
041626 - with equal results.
041627 -
041628 - [On 100616 0832 Jennifer is working on getting Millie a
041629 - treatment option, and expects to submit a solution by
041630 - Friday, 100618. ref SDS 51 OY9N
041632 - ..
041633 - 5. Millie wants a professinal written opinion on viability and
041634 - recommended order for trying additional 21 treatments listed in
041635 - the appeal, ref SDS 25 X77U, so that "everybody is on board"
041636 - with a "road map" for the future after PARP or equal is tried,
041637 - and prepared to treat Millie's cancer as a chronic disease in
041638 - time to be effective, based on Millie's patient profile, as
041639 - ordered by Doctor Johnson and Doctor Rugo, shown in case study
041640 - on 090213 1140. ref SDS 4 PT3N and as set out in Millie's
041641 - claim, reported on 100527 0217, ref SDS 25 X74T
041642 -
041643 - [On 100701 0915 Millie letter to Kaiser and Medicare
041644 - explains written medical opinion, like Doctor Rugo said
041645 - UCSF prepared on 090616, provides "road map to the future"
041646 - guiding treatment for cancer as a "chronic disease," per
041647 - Kaiser's reliance on medical opinions submitted by Doctor
041648 - Benz at UCSF. ref SDS 55 Q85Y
041650 - ..
041651 - Assessing viability of follow on treatments might best be
041652 - accomplished with referral to MD Anderson for analysis in their
041653 - IBC research facility.
041655 - ..
041656 - 6. Millie should be held harmless for any all costs of her
041657 - recovery from medical mistakes, beginning from March 2009.
041658 - Kaiser must therefore repay Millie for all co-payments and such
041659 - other expenses that Millie reasonably incurred flowing from
041660 - UCSF medical mistakes, and which are chargeable to UCSF.
041661 - Jennifer will leave the total as an amount to be determiend by
041662 - evidence.
041663 -
041664 - [On 100610 0352 Millie's letter to the Kaiser and CMS claim
041665 - teams, asks Jennifer to call Rod tomorrow morning to verify
041666 - understandings on issues to be determined by Kaiser
041667 - responding to Millie's claim. ref SDS 45 DZ4X
041669 - ..
041670 - [On 100611 1521 Jennifer reported receiving Millie's
041671 - letter, ref SDS 48 FP5M, submitting the record of telecon
041672 - with Jennifer on 100609 1522. ref SDS 44 036C
041674 - ..
041675 - [On 100611 2326 Millie received Jennifer's letter
041676 - confirming that Kaiser will respond, ref SDS 49 036C, to
041677 - 6-issues listed in the record of telecon on 100609,
041678 - ref SDS 0 XK50, and transmitted to the Kaiser and CMS
041679 - claim teams, and to Doctor Johnson and Doctor Rugo in
041680 - Millie's letter on 100610. ref SDS 45 DZ4X
041682 - ..
041683 - Jennifer asked about expiration on 090602, of Kaiser's referral for
041684 - Millie's radiation treatment at UCSF, dated 090202, and received in
041685 - the record on 090205 1426. ref SDS 3 278T
041687 - ..
041688 - On 090401 1214 Pam in Kaiser's Outside Referrals Department advised
041689 - that expiration of Kaiser Referral contracts is automatically extended
041690 - to 1 year in order for UCSF to provide treatment of Millie's cancer
041691 - ordered in Doctor Rugo's letter to Kaiser on 090129, reported on
041692 - 090130, ref SDS 2 TZ6H, and required to meet Kaiser's obligation for
041693 - standard of care. ref SDS 5 KT9G
041695 - ..
041696 - Additionally, UCSF's obligations for performance under the referral to
041697 - repair defective work begins on the date of discovery. UCSF was
041698 - delayed discovering medical mistakes providing radiation treatments
041699 - until Doctor Hsu's examination at UCSF on 090609, ref SDS 6 W65W, and
041700 - because UCSF ignored warnings of error, requests for testing, and
041701 - requests for timely treatment beginning in March, as shown in Millie's
041702 - claim on 100527. ref SDS 25 X95T
041704 - ..
041705 - UCSF extending responsibiity on 090616, to repair Millie's injuries
041706 - caused by mistakes providing radiation medical services further
041707 - extended Kaisers actionable time period under the referral.
041708 - ref SDS 7 D647
041710 - ..
041711 - UCSF promising on 090716, to continue work for Millie to recover from
041712 - injuries caused by medical mistakes providing radiation treatments on
041713 - referral from Kaiser, extended the referral period. ref SDS 8 EE6P
041715 - ..
041716 - Millie's letter on 100503, asked for notice from Kaiser that UCSF
041717 - performed a commitment to provide a work plan for Millie recover from
041718 - UCSF medical mistakes, and futher notified the parties that failure to
041719 - perofrm would constitute default on UCSF referral obligations.
041720 - ref SDS 19 6X8W
041722 - ..
041723 - Jennifer hung up to collaborate with Kaiser legal counsel.
041724 -
041725 -
041726 -
041728 - ..
0418 -
0419 -
0420 - 1646
0421 -
042101 - Jennifer called back. Received call at home.
042102 -
042103 - Millie participated in this call.
042105 - ..
042106 - Jennifer advised that she sent a letter to Millie requesting to update
042107 - Millie's "Authorized Representative" filed last year on 090530. She
042108 - advised that since Millie did not designate an expiration date, the
042109 - authorization automatically expired 1 year from date of signature,
042110 - and so Millie needs to file an update, so that Jennifer can talk to
042111 - Rod about Millie's claim tomorrow.
042113 - ..
042114 - Jennifer will call Kaiser Park Shadelands Member Services to advise
042115 - that Millie will deliver the authorization form tomorrow moring, which
042116 - the office will submit via fax to Jennifer.
042117 -
042118 - [On 100610 0352 Millie's letter to the Kaiser and CMS claim
042119 - teams, confirms Kaiser's work plan to issue a determination
042120 - tomorrow on 100610, ref SDS 45 036C, and asks Jennifer to
042121 - call Rod tomorrow morning to verify understandings on
042122 - issues to be determined by Kaiser responding to Millie's
042123 - claim. ref SDS 45 DZ4X
042125 - ..
042126 - [On 100610 0930 Millie signed and subitted updated
042127 - Statement of Authorized Representative; it was faxed to
042128 - Jennifer at 0959, with report of successful transmission at
042129 - 1001. ref SDS 46 S07R
042131 - ..
042132 - [On 100611 1521 Jennifer reported receiving Millie's
042133 - letter, ref SDS 48 FP5M, submitting the record of telecon
042134 - with Jennifer on 100609 1522. ref SDS 44 036C
042136 - ..
042137 - Jennifer thanked Millie for submitting a well ordered record with
042138 - issues linked to patient history. She feels chronological order and
042139 - everything numbered provides precision access that saves time coping
042140 - with a very complex situation. Comprehensive, accurate understanding
042141 - enables collaboration among Kaiser departments and with Medicare (CMS)
042142 - to reach an equitable solution in time to be effective for all of the
042143 - parties. Jennifer's assessment of SDS records on the Internet aligns
042144 - with Doctor Sandhu, primary care physician at the VA, who used SDS
042145 - records on the Internet for case management and team care, reported on
042146 - 100104 0930. ref SDS 11 YM7N
042147 -
042148 - [On 100611 1521 Jennifer said SDS records received by
042149 - Kaiser on telecons today accurately report communications
042150 - and actions Kaiser is taking in response to Millie's claim
042151 - filed on 100527. ref SDS 48 734L
042153 - ..
042154 - [On 100624 1616 Jennifer reported that she has enjoyed
042155 - working on Millie's claim, because finding critical details
042156 - is fast and easy. ref SDS 53 EG95
042158 - ..
042159 - [On 100628 1033 Beth at CMS noted that Millie's case is
042160 - very complicated, CMS is learning a lot about health care
042161 - case management, and problems providing quality care, based
042162 - on Millie's records of patient history. ref SDS 54 F54X
042164 - ..
042165 - Jennifer read through a list of what seemed like 4 issues she has
042166 - written out for Kaiser to respond to Millie's claim, reflecting
042167 - discussion in the prior call an hour ago, per above. ref SDS 0 XW4K
042169 - ..
042170 - Tomorrow, Jennifer will submit her list of "issues" via email in time
042171 - to correlate with understandings from the call today, again, per
042172 - agove, ref SDS 0 XW4K, so we can then discuss by telephone to align
042173 - Kaiser's determination tomorrow afternoon with Millie's claim filed on
042174 - 100527 0217. ref SDS 25 IZ7N
042176 - ..
042177 - [On 100610 1327 Jennifer did not call, so called Kaiser and
042178 - left message to call on reviewing issues. ref SDS 47 036C
042180 - ..
042181 - Tomorrow, Jennifer further plans to call Millie's primary care
042182 - physician, Doctor Johnson, to discuss Kaiser's attempts to collaborate
042183 - with UCSF on providing care for Millie in time to be effective
042184 - recovering from UCSF medical mistakes, as shown in the chronology of
042185 - patient history presented in Millie's claim on 100527 0217.
042186 - ref SDS 25 X96P Jennifer will ask the doctor to comment on issues
042187 - presented in Millie's claim, as discussed today, per above.
042188 - ref SDS 0 036C
042189 -
042190 - [On 100611 1521 Jennifer reported that Doctor Johnson has
042191 - not had time to return calls to Case Resolution Department
042192 - on timely resolution of Millie's claim requesting
042193 - life-saving treatment in time to be effective. ref SDS 48
042194 - SK3O
042196 - ..
042197 - [On 100722 1328 Paula reported that Doctor Johnson has not
042198 - had time to return calls from Case Resolution Department on
042199 - resolving Millie's request for care in time to be effective
042200 - recovering from UCSF medical mistakes. ref SDS 56 036C
042202 - ..
042203 - Jennifer will send an email to confirm understandings from the call
042204 - today that Kaiser will determine "issues" discussed today, per above.
042205 - ref SDS 0 XK50 She will call tomorrow to report Kaiser's
042206 - determination of the claim, due COB 100610, as reported by Irene in
042207 - teleconference earlier to day with Medicare and Kaiser claim teams.
042208 - 100609 1300, ref SDS 43 6F64
042209 -
042210 - [On 100610 0352 Millie's letter to the Kaiser and CMS claim
042211 - teams, confirms Kaiser's work plan to issue a determination
042212 - tomorrow on 100610, ref SDS 45 036C, and asks Jennifer to
042213 - call Rod tomorrow morning to verify understandings on
042214 - issues to be determined by Kaiser responding to Millie's
042215 - claim. ref SDS 45 DZ4X
042217 - ..
042218 - [On 100610 1327 Jennifer did not call, so called Kaiser and
042219 - left message to call on reviewing issues. ref SDS 47 036C
042221 - ..
042222 - Following recent history can further guide Jennifer's discussion with
042223 - Doctor Johnson tomorrow...
042224 -
042225 - 1. Doctor Johnson's letter advising that
042226 - Doctor Rugo has not returned his
042227 - calls............................... 100606 2314, ref SDS 36 036C
042229 - ..
042230 - 2. Meeting with Doctor Johnson reporting
042231 - he could not communicate with Doctor Rugo
042232 - by email or telephone for a
042233 - month............................... 100601 0830, ref SDS 29 P59L
042235 - ..
042236 - 3. Millie's letter to medical team, Doctor
042237 - Johnson and Doctor Rugo, submitting
042238 - agenda for meeting with Doctor Johnson
042239 - and requesting Kaiser's work plan
042240 - for recovering from UCSF
042241 - medical mistakes.................... 100601 0136, ref SDS 28 1Q5W
042243 - ..
042244 - 4. Doctor Rugo's letter reporting she would
042245 - speak with Doctor Johnson about
042246 - Millie's care....................... 100501 2017, ref SDS 15 456L
042248 - ..
042249 - 5. Millie requests immediate treatment for
042250 - 11th relapse to recover from medical
042251 - mistakes getting radiation treatment
042252 - at UCSF on referral from Kaiser,
042253 - and in time to be effective
042254 - before cancer cascades
042255 - out of control...................... 100501 1037, ref SDS 14 U44V
042257 - ..
042258 - 6. Doctor Johnson advises that Millie needs
042259 - treatment targeted to genetic profile of
042260 - her cancer in order to recover from 11th
042261 - relapse, becasue Millie's cancer
042262 - has mutated to resist
042263 - chemotherapy........................ 100427 0830, ref SDS 13 SJ6N
042265 - ..
042266 - 7. PARP targeted to genetic profile of cancer
042267 - and to Millie's triple negative status
042268 - minimal side effects, reviewed by
042269 - Doctor Johnson at
042270 - Kaiser.............................. 100112 0830, ref SDS 12 N586
042271 -
042273 - ..
042274 - While we talked, received Jennifer's letter via email...
042275 -
042276 - 1. Subject: Authorization request for your completion
042277 - Date: Wed, 9 Jun 2010 17:05:58 -0700
042281 - ..
042282 - 2. Per our conversation, attached is the form that requires yours
042283 - and Rod's signature. You can either fax or mail, or bring in
042284 - the form to any local Member Services.
042286 - ..
042287 - 3. Thank you,
042289 - ..
042290 - 4. Please feel free to contact me for any questions.
042291 -
042301 - *****************************
042303 - ..
042304 - Jennifer's letter attaches the following...
042305 -
042306 - 1. Kaiser Permanente
042307 -
042308 - Kaiser Foundation Health Plan, Inc.
042309 - Kaiser Foundation Hospitals
042311 - ..
042312 - The Permanente Medical Group, Inc.
042313 - Southern California Permanente Medical Group
042314 -
042316 - ..
042317 - 2. STATEMENT OF AUTHORIZED REPRESENTATIVE Page 1 of 2
042319 - ..
042320 - I understand that Kaiser Permanente will not condition
042321 - treatment, payment, enrollment, or eligibility for benefits on
042322 - my providing or refusing to provide this authorization. PART
042323 - A: If you wish to give authority to another party to file a
042324 - complaint, grievance, Medicare Review, or an appeal on your
042325 - behalf, please complete the following information. If you wish
042326 - this person to receive Protected Health Information (PHI)
042327 - regarding your treatment and care, you must check the
042328 - appropriate box(es) below and you and your representative must
042329 - both sign and date this form. Please return the completed form
042330 - to the Member Services office handling your case.
042332 - ..
042333 - 3. Your Name and Address
042337 - ..
042338 - Daytime Phone #
042342 - ..
042343 - Alternate Phone #
042345 - ..
042346 - 4. Medical Record #
042350 - ..
042351 - 5. Medicare #
042355 - ..
042356 - 6. PART B: I hereby authorize the person named below to represent
042357 - me regarding concerns with the quality of care or service I
042358 - have received from Kaiser Permanente, or in questions regarding
042359 - coverage of services or supplies I may be entitled to as a
042360 - member of Kaiser Foundation Health Plan, Inc. (KFHP). I
042361 - understand that this authorization is voluntary and, if I
042362 - choose to do so, I have the right to revoke it in writing to
042363 - KFHP and to my designated representative. KFHP and my
042364 - designated representative will no longer use or disclose my
042365 - PHI, except to the extent KFHP or my designated representative
042366 - has taken action in reliance upon this authorization.
042368 - ..
042369 - 7. Name of Designated Person
042373 - ..
042374 - Address
042378 - ..
042379 - City
042383 - ..
042384 - State
042388 - ..
042389 - Zip Code
042393 - ..
042394 - Daytime Phone #
042395 -
042396 - (925) 680 8947
042398 - ..
042399 - Evening Phone #
042400 -
042401 - ( )
042403 - ..
042404 - 8. X I authorize KFHP to disclose Protected health Information
042405 - regarding my medical condition and care and/ or payment
042406 - information to the above named individual. This
042407 - information must be relevant to the request filed with
042408 - Member Services on May 27, 2010 (date of request).
042410 - ..
042411 - 9. SPECIFY Check the box and initial to specify which type of
042412 - authorization is to be disclosed
042414 - ..
042415 - RECORDS:
042417 - ..
042418 - X MEDICAL INFORMATION
042419 - X PSYCHIATRIC INFORMATION
042421 - ..
042422 - INITIAL
042424 - ..
042425 - June 9, 2010
042427 - ..
042428 - SIGNATURE
042429 - DATE
042430 -
042431 -
042432 - DRUG/ALCOHOL INFORMATION
042434 - ..
042435 - SIGNATURE
042436 - DATE
042437 -
042438 - RESULTS OF AN HIV BLOOD TEST
042440 - ..
042441 - SIGNATURE
042442 - DATE
042443 -
042445 - ..
042446 - 10. X OTHER HEALTH INFORMATION (specify below)
042448 - ..
042449 - Specify the records to be disclosed:
042451 - ..
042452 - All communications of any kind.
042454 - ..
042455 - 11. X This authorization shall become effective immediately and
042456 - shall remain in effect until the earlier or final resolution
042457 - of my request or December 31, 2015 (specify date).
042458 -
042460 - ..
042461 - 12. STATEMENT OF AUTHORIZED REPRESENTATIVE Page 2 of 2
042462 -
042463 - REVOCATION: This Authorization is also subject to written
042464 - revocation by the member/patient at any time. The written
042465 - revocation will be effective upon receipt, except to the extent
042466 - that the disclosing party or others have acted in reliance upon
042467 - this Authorization.
042469 - ..
042470 - 13. REDISCLOSURE: I understand that the recipient may not lawfully
042471 - further use or disclose the health information unless another
042472 - authorization is obtained from me or unless such use or
042473 - disclosure is specifically required or permitted by law.
042475 - ..
042476 - 14. Your Signature:
042477 -
042481 - ..
042482 - Date:
042484 - ..
042485 - 15. PART C:
042487 - ..
042488 - I am authorized to sign this authorization on behalf of
042489 - Mildred Buck and on the basis of:
042491 - ..
042492 - Legal Authority (Power of Attorney, etc.)
042494 - ..
042495 - XX Written Designation by Member
042497 - ..
042498 - Parent, Guardian, or other individual acting in loco parentis
042500 - ..
042501 - 16. Authorized Representative:
042502 -
042506 - ..
042507 - Date:
042508 -
042510 - ..
042511 - Patient has a right to a copy of this form
042513 - ..
042514 - 00139-000 (REV. 6-03) PAGE 1 OF 2 HIPAA COMPLIANT
042515 - FOR SPANISH USE 00139-001; CHINESE USE 00139-002
042516 - NS-1062 (REV. 6-03) PAGE 1 OF 2 HIPAA COMPLIANT
042517 - FOR SPANISH USE NS-1071; CHINESE USE NS-1075
042518 -
042519 -
042520 -
042521 -
042522 -
042523 -
0426 -