CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C1 0000. ref SDS B9 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 58
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 58 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 59 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 60 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 62 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 62 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 63 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 64 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 65 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 66 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 67 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 68
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 69 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 70 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 71 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 72 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 73 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 59 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 60
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 78 036C  Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 78 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 78 UN4M  Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 78 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 78 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 79 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 80 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 81 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 82 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 73 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 83 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 84 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 84 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 85 036C
041068 -  ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 86 036C  Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 86 C354  Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 86 G84Q
041075 -  ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 87 036C  Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 87 8O4H  Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 87
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 88 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 89 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 90 036C
041097 -  ..
041098 - On 100611 1451 Jennifer advised Kaiser extended the date for
041099 - responding to Millie's claim from 100610 to 100624, based on Millie
041100 - filing updated statement of authorized representative. ref SDS 94 036C
041101 - Jennifer reported she reviewed 6-issues discussed on 100609, and will
041102 - address these issues responding to Millie's claim. ref SDS 94 FQ4G
041103 - Jennifer asked how Kaiser can treat Millie to recover from UCSF
041104 - medical mistakes, if Millie refuses chemotherapy and has entered
041105 - Hospice. ref SDS 94 FQ4M
041107 -  ..
041108 - On 100611 2326 Millie received Jennifer's letter confirming the date
041109 - for Kaiser to respond to Millie's claim has been extended to 100624,
041110 - ref SDS 95 CV4O, and further advising that issues Kaiser will determine
041111 - responding to Millie's claim for recovering from UCSF medical
041112 - mistakes, ref SDS 95 036C, are as set out in the record for telecon on
041113 - 100609. ref SDS 90 XK50  Jennifer will call on 100615, to report
041114 - progress on respnding to Millie's claim. ref SDS 95 6P53
041116 -  ..
041117 - On 100614 0257 letter to Kaiser Medicar CMS claim team requests
041118 - immediate written proposal evaluating treatment options for Millie to
041119 - consider. ref SDS 96 036C
041121 -  ..
041122 - On 100616 0832 called Jennifer about her plan to call yesterday on
041123 - Tuesday to report progress Kaiser responding to Millie's claim, as set
041124 - out in Jennifer's letter on 100611. ref SDS 97 036C   Jennifer called
041125 - back to ask if Millie wants UCSF or Kaiser to pay for her damages
041126 - caused by UCSF medical mistakes. ref SDS 97 PSSV  Jennifer reported
041127 - delays communicating with Millie's medical team have delayed making
041128 - arrangements for Millie to start treatment recovering from UCSF
041129 - medical mistakes. ref SDS 97 OY4T  She plans to call on Friday, 100618,
041130 - to report progress responding to Millie's claim. ref SDS 97 1K5J
041132 -  ..
041133 - On 100618 0843 called Jennifer at Memeber Case Resolution Department
041134 - about progress responding to Millie's claim. ref SDS 98 036C
041136 -  ..
041137 - On 100620 1112 letter to Kaiser claim team with copy to Medicare, and
041138 - the medical team requests call on Monday 100621, planned for previous
041139 - Friday, 100628, to report progress getting Millie treatment.
041140 - ref SDS 99 036C  Recommends that delay communicating with medical team
041141 - that has delayed Millie starting treatment in time to be effective,
041142 - ref SDS 99 L59P, can be solved by hiring MD Anderson. ref SDS 99 L59X
041144 -  ..
041145 - On 100621 0853 called for Jennifer and left several messages,
041146 - including for her team lead. ref SDS A1 036C  Nobody had time today
041147 - for calling back. ref SDS A1 OP3N
041149 -  ..
041150 - On 100622 1027 Jennifer called and advised that Doctor Johnson
041151 - responded to request for comment on Millie's claim saying he cannot
041152 - provide care for Millie because she entered Hospice on 100601,
041153 - ref SDS A3 036C; recommended Jennifer check Kaiser's medical chart for
041154 - Millie meeting with Doctor Johnson to see Millie was given no choices
041155 - except to enter Hospice in order to avoid further pain and suffering.
041156 - ref SDS A3 NX68
041158 -  ..
041159 - On 100622 1511 letter to claim team and Medicare, and to Millie's
041160 - medical team confirming understanding in Jennifer's call that Millie's
041161 - medical team at Kaiser seems to refuse Millie standard of care to
041162 - recover from UCSF medical mistakes, because she was forced to enter
041163 - Hospice to get relief from pain caused by UCSF medical mistakes.
041164 - ref SDS A4 036C  UCSF delays compounded Millie's injuries, pain, and
041165 - suffering; caution must be exercised to enable recovery, based on
041166 - Millie's right to life. ref SDS A4 575U   Millie's patient history
041167 - shows the doctor's only issue, ref SDS A4 576V, is having time to
041168 - providing standard of care for Millie to recover from medical
041169 - mistakes, and if not, then Kaiser should assign someone who does.
041170 - ref SDS A4 583Y  Kaiser has violated Millie's human rights; a woman's
041171 - right to choose life for herself, should be no less than the right to
041172 - choose for her unborn child, since the right to life and due process
041173 - are protected by the US Constitution. ref SDS A4 584W  Kaiser can
041174 - easily solve the time problem by hiring other people to do the work,
041175 - and charging UCSF. ref SDS A4 585P
041177 -  ..
041178 - 100624 1616 Jennifer called and asked to extend Kaiser's response to
041179 - Millie's claim another day or so, for review with her boss, and with
041180 - the customer. ref SDS A5 036C  Jennifer the original date for Kaiser to
041181 - respond on 100610, required by statute, and then amended to today on
041182 - 100624, can be further amended, and cited unclear authority about 30
041183 - days instead of 14. ref SDS A5 EG5P  Agreed that extending Kaiser's
041184 - response another few days until tomorrow, or Monday, is an acceptable
041185 - risk, even though Millie's cancer markier has increased significantly
041186 - to over 1000, and so that an equitable solution can be implented that
041187 - allows treatment in time to be effective for Millie. ref SDS A5 EG73
041188 - Jennifer will submit her draft response, and call tomorrow for
041189 - discussing Kaiser's solution. ref SDS A5 H98M
041191 -  ..
041192 - On 100625 0852 letter to Kaiser and Medicare claim teams confirming
041193 - Kaiser's request to extend date for responding to Millie's claim
041194 - another few days until Monday in order to get comprehensive solution.
041195 - ref SDS A6 036C
041197 -  ..
041198 - On 100626 0917 received letter from Cherry at Medicare, ref SDS A7
041199 - 036C, submitting CMS regulations, that control due date for Kaiser to
041200 - respond to Millie's claim. ref SDS A7 N64I
041202 -  ..
041203 - On 100628 0228 letter to claim teams at Medicare and Kaiser asking how
041204 - CMS regulations received on 100625, apply to extend Kaiser's response
041205 - date for expediting Millie's recovery. ref SDS A8 036C
041207 -  ..
041208 - On 100628 1033 called CMS Medicare for Beth Simone on regulations for
041209 - Kaiser to respond to Millie's claim.
041211 -  ..
041212 - On 100628 2318 submitted record of telecon with CMS, ref SDS B0 036C,
041213 - and that CMS learned today that Kaiser changed Millie's claim to a
041214 - Grievance, and notified CMS that Kaiser intends to delay response
041215 - until 100710, to Millie's claim filed on 100527.
041217 -  ..
041218 - On 100629 00003 received letter from Cherry transmitting Grievance
041219 - procedures, cited in the telecon yesterday as a change Kaiser made to
041220 - delay responding until 100710, to Millie's claim filed on 100527.
041221 - ref SDS B1 036C  Review of Grievance regulations show Kaiser required
041222 - to make timely response based on patient health. ref SDS B1 PN5S
041224 -  ..
041225 - On 100629 0013 letter thanks CMS for submitting regulations on
041226 - Grievance procedures, and notes requirements for Kaiser to respond
041227 - prior to maximum allowed of 30 days, based on patient health.
041228 - ref SDS B2 036C
041230 -  ..
041231 - On 100629 1631 called Medicare (CMS) on results of their
041232 - teleconference with Kaiser on expediting response to Millie's claim.
041233 - ref SDS B3 036C
041235 -  ..
041236 - On 100630 0027 Millie thanks Doctor Johnson for reporting on 100606,
041237 - that UCSF did not call Kaiser to provide care for Millie to recover
041238 - from UCSF medical mistakes. ref SDS B4 036C; she reports blood counts
041239 - are good, but cancer progressing because treatment was stopped on
041240 - 100601, for pain relief from chemotherapy. ref SDS B4 V83U  Kaiser has
041241 - deferred responding to Millie's claim, ref SDS B4 V87S, and needs to
041242 - know how soon her health status requires Kaiser to make a response.
041243 - ref SDS B4 V88T  Millie asks about deferring the meeting with Doctor
041244 - Johnson tomorrow, until Kaiser responds to Millie's claim, or, Millie
041245 - would love to meet, if Doctor Johnson has communicated with Doctor
041246 - Rugo on a work plan for Millie to recover from UCSF medical mistakes.
041247 - ref SDS B4 V89X
041249 -  ..
041250 - On 100630 1148 Doctor Johnson notfies Millie, and the Kaiser claim
041251 - team that he is confused about Millie's case, because Kaiser has
041252 - deferred determination on urgent requirement for care. ref SDS B5 036C
041253 - Doctor Johnson notes Millie is in Hospice and states that Millie's
041254 - disease is resistant to all forms of therapy, and that entering
041255 - Hospice is based on patient desire to forego therapy. ref SDS B5 PY4J
041256 - He asks if Millie wants to dis-enroll from Hospice. ref SDS B5 OY5G
041257 - Doctor Johnson further notes that public domain email conflicts with
041258 - HIPAA regulations. ref SDS B5 0W5U
041260 -  ..
041261 - On 100630 1537 Millie notified medical team and claim team, thanking
041262 - Doctor Johnson for his letter commenting on Millie feeling better
041263 - after ending chemotherap.  Confirms Doctor Johnson's intent to defer
041264 - meeting scheduled for tomorrow until after Kaiser responds to Millie's
041265 - claim, and further confirms Doctor Johnson has still not communicated
041266 - with Doctor Rugo on UCSF providing care for Millie to recover from
041267 - UCSF medical mistakes. ref SDS B6 M86X  Advises that Doctor Johnson's
041268 - assertion that Millie's cancer now resists all forms of therapy
041269 - conflicts with the record; Doctor Johnson advised that finding
041270 - effective treatment requires experimentation; Millie's first treatment
041271 - failed, and had to be switched. ref SDS B6 M87Q  When UCSF discovered
041272 - medical mistakes, UCSF failed to provide necessary and reasonable care
041273 - for Millie to recover, and instead prescribed chemotherapy, which was
041274 - not effective and caused unbearable pain and suffering, causing Millie
041275 - to enter Hospice. ref SDS B6 M84P  The only evident purpose for
041276 - Millie's death is to avoid accountability from medical mistakes and
041277 - avoid cost of recovery, by making Millie suffer, and making Medicare
041278 - pay, while Millie is actually innocent, and Medicare is innocent.
041279 - ref SDS B6 M84S  Millie sent 44 letters to medical team requesting
041280 - targeted treatment to recover from UCSF medical mistakes, and
041281 - reporting pain and suffering from chemotherapy; so, on 100601, Millie
041282 - entered Hospice for pain relief for chemotherapy. ref SDS B6 M84Y
041283 - Millie cannot dis-enroll from Hospice providing pain medication until
041284 - Kaiser provides standard of care to recover from UCSF medical
041285 - mistakes. ref SDS B6 M93V  Millie explains benefits to saving lives,
041286 - time, and money using public domain email. ref SDS B6 M94W  Millie
041287 - notes Doctor Johnson's report today shows Kaiser has violated Medicare
041288 - regulations by delaying response to her claim longer than justified by
041289 - Millie's health status. ref SDS B6 M96P
041291 -  ..
041292 - On 100701 0915 Carol called this morning saying she is the Chief of
041293 - Hospice and advised that she was told that Millie wants to dis-enroll
041294 - from Hospice.  Millie sent a letter to the medical team, and claim
041295 - teams confirming understandings from the call with Carol. ref SDS B7
041296 - 036C  Millie advised Carol that Millie entered Hospice for pain relief
041297 - for chemotherapy, and so she cannot dis-enroll from Hospice providing
041298 - pain medication until Kaiser provides standard of care to recover from
041299 - UCSF medical mistakes. ref SDS B7 Q85S  Millie explains she wants a
041300 - written medical opinion on treatments lined up for her to recover from
041301 - UCSF medical mistakes that provides a "roadmap to a future worth
041302 - living." ref SDS B7 Q85Y
041304 -  ..
041305 - On 100701 1140, meeting this morning scheduled during a prior meeting
041306 - at Kaiser on 100601, ref SDS 75 7E4S, was canceled because Doctor
041307 - Johnson's letter yesterday, said nothing about receiving instructions
041308 - from Kaiser's claims department on solving Millie's claim for care to
041309 - recover from UCSF medical mistakes, ref SDS B5 036C   Since Doctor
041310 - Johnson was not authorized to provide care requested in Millie's claim
041311 - on 100527, ref SDS 71 IZ7N, meeting would jeperodize Millie's rights
041312 - in the case by adding or otherwise modifying her statement of claim.
041313 - ref SDS B8 036C
041315 -  ..
041316 - On 100701 1213 Lois called and talked to Rod for explanation of
041317 - Millie's claim, and planned to talk with Doctor Johnson about a
041318 - resolution. ref SDS B9 036C
041320 -  ..
041321 - On 100702 1424 Millie received letter from Doctor Johnson submitting
041322 - Kaiser's lab report on results of Millie's blood test on 100622, and
041323 - without comment except the doctor circled with ink CA 15-3 1116.
041324 - ref SDS C0 036C
041326 -  ..
041327 - On 100702 1612 Lois called and reported discussing Millie's claim with
041328 - Doctor Johnson, who evidently indicated he cannot find on the Internet
041329 - a provider willing to treat Millie with PARP. ref SDS C1 036C  Lois
041330 - asked to talk with Millie in order to verify what Millie wants in her
041331 - claim filed on 100527.  Lois was referred to Millie's claim, and to
041332 - the letter to Kaiser on 100701, confirming Millie's telecon with
041333 - Carol, with the Kaiser Hospice program. ref SDS B7 036C
041335 -  ..
041336 - On 100705 2050 letter to Kaiser and Medicare claim teams asking for
041337 - remedies for damanges caused by Kaiser delaying response to Millie's
041338 - request for urgent care. ref SDS 0 036C
041339 -
041340 -
041341 -
041343 -  ..
0414 -
0415 -
0416 - Progress
0417 -
041701 - There are several issues that need to be addressed by Kaiser...
041702 -
041703 -    1.  On 100527, Millie filed a claim requesting necessary and
041704 -        reasonable treatment to save her life by recovering from
041705 -        injuries caused by UCSF medical mistakes, and approximately 21
041706 -        solutions are ready and available, but have been wrongfully
041707 -        withheld for the past year, since 090716. ref SDS 71 IZ7N
041709 -         ..
041710 -    2.  On 100602 Eileen Moffitt called and advised that Millie
041711 -        entering Hospice for medication to relieve pain from UCSF
041712 -        medical mistakes is not grounds for Kaiser to deny Millie the
041713 -        right to recover from UCSF medical mistakes that occurred
041714 -        providing radiation services on referral from Kaiser.
041715 -        ref SDS 78 UN5P
041717 -         ..
041718 -    3.  On 100609, Kaiser called in conference with Medicare (CMS), and
041719 -        advised that Millie's claim is being processed as "not denied,"
041720 -        ref SDS 89 Y29M, and that Medicare regulations require Kaiser
041721 -        to respond in time for care to be effective, and no later than
041722 -        100610, based on Kaiser receiving the claim on 100527.
041723 -        ref SDS 89 6F64
041725 -         ..
041726 -    4.  On 100610, Kaiser did not respond to Millie's claim as required
041727 -        by regulations, and did not return calls. ref SDS 93 036C
041729 -         ..
041730 -    5.  On 100611 1521, Jennifer called and advised that Kaiser did not
041731 -        respond to Millie's claim on 100610, as reported is required by
041732 -        regulations, but somehow extended Kaiser's date of response to
041733 -        100624, based on Millie filing a Statement of Authorized
041734 -        Representation. ref SDS 94 FP5L
041736 -         ..
041737 -    6.  On 100611 2326, Millie received Jennifer's letter confirming
041738 -        that Kaiser will respond, ref SDS 95 036C, to 6-issues listed
041739 -        in the record of telecon on 100609, ref SDS 90 XK50, and
041740 -        transmitted to the Kaiser and CMS claim teams, and to Doctor
041741 -        Johnson and Doctor Rugo in Millie's letter on 100610.
041742 -        ref SDS 91 DZ4X
041744 -         ..
041745 -    7.  On 100624, Kaiser called and requested another day to file a
041746 -        response, ref SDS A5 LE4G, to Millie's claim filed on 100527.
041748 -         ..
041749 -    8.  On 100625 0852, letter to claim teams at Kaiser and Medicare,
041750 -        and to medical team confirms Kaiser's response deferred several
041751 -        days for deliberation to increase accuracy of solution.
041752 -        ref SDS A6 1X5R
041754 -         ..
041755 -    9.  On 100626 0917 received letter from CMS where Cherry submits
041756 -        CMS regulations on MA response date for Millie's claim.
041757 -        ref SDS A7 036C  Medicare regulations...
041759 -         ..
041760 -        422.570(d) says that...
041761 -        If an enrollee requests an MA organization to provide an
041762 -        explanation of a practitioner's denial of an item or service,
041763 -        in whole or in part, the MA organization must give the enrollee
041764 -        a written notice. ref SDS A7 JZ5W
041766 -         ..
041767 -        422.570(f) says that...
041768 -        "If the MA organization fails to provide the enrollee with
041769 -        timely notice of an organization determination as specified in
041770 -        this section, this failure itself constitutes an adverse
041771 -        organization determination and may be appealed." ref SDS A7
041772 -        05U2
041774 -         ..
041775 -   10.  On 100628 0228 letter asks claim teams how CMS regulations are
041776 -        applied for extending response to Millie's claim beyond 14 days
041777 -        cited in 422.570, and suggests another claim team conference
041778 -        call can clarify everyone is on track. ref SDS A8 KH8Y
041780 -         ..
041781 -   11.  On 100628 1033 during telecon Medicare advised that Kaiser
041782 -        verbally notified CMS, without notice to Millie, of having
041783 -        changed the classification of Millie's claim to a grievance
041784 -        procedure and as a result intends to delay until 100710,
041785 -        responding to Millie's claim filed on 100527, seeking
041786 -        emergency life-saving treatment. ref SDS A9 RO9X
041788 -         ..
041789 -   12.  On 100629 0003 Millie received from Medicare additional CMS
041790 -        regulations for Kaiser to respond to her claim as expeditiously
041791 -        as the case requires based on health status, ref SDS B1 6J4O;
041792 -        and responding to verbal representation during a call from CMS
041793 -        that Kaiser without notice changed the classification of
041794 -        Millie's claim to a grievance procedure, reported, 100628 1033,
041795 -        ref SDS A9 RO9X
041796 -
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0419 -