From: KAISER PERMANENTE .,
NORTHERN CALIFORNIA REGION
Kaiser Foundation Health Plan, Inc., CA entity Number
Member Services Department
Robert Dean, Senior case manager
P.O. Box 367
Roseville, CA 95661
Dear Fatekh Vergasov:
1. We have completed our review of your request for
Xxxxxx Xxxxxxx to amend (or change back) the quantity of unnamed
prescriptions allowing you to receive a 100 day supply without the need to
complete laboratory work. After careful review of your records and other
relevant information, your request has been denied. The following
individuals participated in the review of your request: MD, Chief Emergency
Medicine Santa Clara
1.1. Are you
Sick? or both? Why am I
asking? Because according to
Mark Twain, quote:
"Only kings, presidents, editors, and people with
have the right to use the editorial "we"... Since you are certainly not
King, and neither President, nor editor,
suggests you are one of those people with
on this conclusion and your text analysis, shown below, may I name you
as "Permanently Sick Kaiser" or just "PSK"?
freaky logic and bureaucratic way to answer my claim questions, your
artful interpretation, suspected unexpected serious adverse reaction...
prove your probable
case went too far i.e. to advanced stage of a disease, and effect your
capability to defend us (Customers). Why? Because you prefer to act as
Trade Union activist, who defends his/her own members, no matter what...
1.3. Poor boy with
I suspect "MD, Chief Emergency Medicine Santa Clara" is not an
"individuals" of any kind... In is post, job position, occupational
2. This denial was
based on the following reasons:
Kaiser Permanente is
your partner in health care. Active communication between you and your
physician, as well as your other health care professionals, enables us
to provide you with appropriate and effective health care
2. 1. Who care your
reasons? You was ask to provide Code, Law, Regulation, etc. bases. But
you fail to accomplish so far... Because you are not capable,
2.2. Word "Partner"
by default describes persons or entities with opposite interests, who,
- and it is true, - may cooperate under certain conditions... unknown to
you. Why? Because I suspect you prefer Kaiser
main legal base of your business activity. But Customers are not your
slaves... and you are not Ruler of any kind... We are "people
of California", who "establish this Constitution" of this State in
our own interests. So, behave yourself accordingly, please... Learn from
dogs, cats, other pets, who live by providing Love to those, who give
them food, shelter and opportunity to feed they Childs...
3. Our providers
make every effort to provide necessary professional services in a manner
compatible with the patient's wishes
3.1. What are you
talking about? None of your physicians
ever speaks with me, respect me or treat me as a Customer
regarding specific medications, dosages and quantity refills are made by
the treating provider, as such your request to request for refills of
your prescriptions to be written at a 100 day supply has been denied
because it is not medically indicated at this time.
3.1. From 2009 said "treating provider" use to prescribe 100 day pills
supply, without problem... After that your
change his mind without any medical reasons. Maybe he got tapeworms
3.2. "is not medically indicated"... How
knows???, if I not visited him since 2009 and not pass laboratory test
since 2011. And your
ever see me since???
Practitioner just decide to force me to visit his office and his
laboratories, which have reason
not to visit. Another brilliant goal of him was to sell me peals at
price, which is 4-6 times higher per single tablets, and this way gain
more easy money for Kaiser Permanente. But you fail to check that facts,
because you simply don't care about facts, which may ruin you
4. This decision was made in consultation with the Kaiser Permanente
Mountain View Medical Offices Internal Medicine Chief, who explained that
you have not had an office visit since 2009, and have not had necessary
laboratory blood testing done for diabetes, hypertension, and cholesterol
since May of 2011.
4.1. How did you find that Great source!?
The Kaiser Permanente Member Issue Resolution Committee has recommended that
you follow up with Mr. XXXXXXX at your earliest convenience
4.2. What is legal status of your "recommendations"? The same as my own
recommendation to all, who want to loose weight: "Go to the Moon, where
every pound will weight about 2 ounces"?.
5. Additionally, please refer to your 2013 Evidence of Coverage (EOC),
through Midpen Housing, Purchaser 1048203, under the section titled
"Definitions", it states: 031 Commercial Grievance Denial 02/26/13
"Medically Necessary: A Service is Medically Necessary if it is
medically appropriate and required to prevent, diagnose, or treat your
condition or clinical symptoms in accord with generally accepted
professional standards of practice that are consistent with a standard
of care in the medical community"
in accord with generally accepted professional standards of practice
that are consistent with a standard of care in the medical community"
looks like meaningless to Customers so called "Verbal
Diarrhea" with goal
to defend all-too-common medical community", i.e. medical Trade Union.
But you have to defend Customers, whose rights prevail any other
statement has similar value like "Sacramento is the capital of the State of
California", i.e. it creates no my duty to accept your abusive service or
follow you instructions till I am in the pink and right minded
5.3. You forgot to
mention "to cure", because you even have such a goal...
5.3. Your main
conceptual problem of your physicians (other specialists are ok) is - they
don't understand subordination. Who is Customer and who is Service provider.
And who exists for whom...
6. On October 21,
2013, when you submitted your online grievance form to the Kaiser
Permanente Member Services Contact Center, you explained that you felt
that by Mr. XXXXXXX requesting that you complete necessary laboratory
work, his behavior was abusive and aggressive. Your concerns were
forwarded to both the Mountain View Medical Offices Internal Medicine
Chief and the Kaiser Permanente Member Services Quality Nurse Consultant
for review and internal action as necessary.
November 4, 2013, you had left me a voice message requesting that we
communicate via e-mail.youagainaskedthatwecommunicateviae .•mail with a
letter you sent to the Member Case Resolution Center, received on
November 8, 2013. As I explained in my phone message to you,
unfortunately, our department does not have the option to communicate
with our member's via e-mail.
Your letter of
November 8, 2013, also asked that you be provided with an address that
was not a Post Office Box. I have confirmed with a Kaiser Permanente
Member Case Resolution Center Team Lead that all correspondence must be
sent to the center P.O. Box, or be faxed to 925-369-0397, in ensure
6.1. Who care opinion of your "Kaiser Permanente Member Case Resolution
Center Team Lead", which was created and acting on legal bases, unknown
to Customers and public, So, said Center can use verb "must" at its
kitchen only till his wife explain him, who he is and what is his real
value in the present World... You are wrong because:
A. Information in USA should circulate without encumbrance! Some
exclusions apply. But my case is not in the list of such exclusions...
Because it is not "Top secret of America" and not secret at all.
B. But it is You, who must be "Green" in California.
No exclusions apply
6.2. By default none of P.O. box accepts Certified mail and return
receipt to sender. And this abuse my right to send you certified. To use
P.O. boxes is famous bureaucratic trick
6.3. Maybe you SK shouldn't exist in California at all with such illegal
Name and such bureaucratic? May it is time to annul your business
registration here in California?
7. Your letter
included a copy of an article found on an unknown website. As it was not
clear what your intent was with the article, I provided it, along with
your full letter, to the Member Issue Resolution Committee for
additional review as your written testimony. Please be assured that we
take your concerns seriously, and the issue you have raised will be
addressed by the appropriate department(s) within the Kaiser Permanente
Medical Care Program.
7.1. Said well known website article just show you therapists everyday
real practice. Even veterinarian speaks with his dogs, cows, horses and
other animals. But your Service providers works like "pill pushers"
[Named this way by therapists
colleges] or heartless vending machines.
7.2. Single Doctor's specialty "Physician" was split by you into two:
A. "Pill pusher", who sell pills and cannot treat by using just
Word. You forgot power of
Word on purpose, not by accident... Because this way you gain easy
B. Psychologist who can treat by using just
7.3. Your must serve Customer's interest first, not yours, which you'll
reach only by satisfying Customers. This idea is basic idea of any
Service. Very often I am not only Customer, but Service provider too...
So I certainly know, what I am talking about
7.4. We "take your concerns seriously". This is not heroism of any kind,
this is just your duty, because you are Service provider and you want to
survive in this World
8. We at Kaiser Permanente continually strive to meet the expectation of our
members for high standards in all aspects of their health care. All member
concerns are carefully reviewed and handled, with the goal of preventing
similar concerns and ensuring that we continue to provide quality health
care and service to all our members, consistent with both the laws governing
health care service plans and our own internal policies and procedures.
Please understand, however, that all such reviews are subject to statutory
confidentiality and privacy considerations, and results cannot be disclosed.
8.1. Stop striving. Just do your job properly...
8.2. You still have possibility to re-think and re-design this letter,
based on wrong ideas and presumptions
8.3. Customers will notice changes, if any will happened
On behalf of the
Kaiser Permanente Member Services Department, please accept our apology
for any unfavorable experience you may have encountered. We regret the
dissatisfaction regarding your expectations of the level of care
provided to you. Access to Relevant Materials Used by the Plan
8.2. Fix service instead
8.3. Do you want me to report Health
insurance I am not given any pills from you since August, 2013?
You have a right to access and receive a free copy of any materials
(documents, records or other information) relevant to your case. Relevant
materials are those that: 031 Commercial Grievance Denial 02/26/13
8.3. I do know my rights
and duties. I am son of criminal attorney at law and I was born not
No thanks so far for
you business style and behavior