Fatekh Vergasov
Communications with Kaiser
regarding it's therapy style



Kaiser Foundation Health Plan, Inc., CA entity Number C0299541

Member Services Department

Robert Dean, Senior case manager


P.O. Box 367

Roseville, CA 95661

November 20,2013


RE: Fatekh Vergasov, MRN: XX-XXXXXXXX


Dear Fatekh Vergasov:


1. We have completed our review of your request for Nurse Practitioner 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


Customer's comments:


1.1. Are you Kaiser? or Sick? or both? Why am I asking? Because according to Mark Twain, quote: "Only kings, presidents, editors, and people with tapeworms have the right to use the editorial "we"... Since you are certainly not King, and neither President, nor editor, Common sense suggests you are one of those people with tapeworms... Based on this conclusion and your text analysis, shown below, may I name you as "Permanently Sick Kaiser" or just "PSK"?
1.2. Your freaky logic and bureaucratic way to answer my claim questions, your artful interpretation, suspected unexpected serious adverse reaction... prove your probable tapeworms 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 tapeworms, I suspect "MD, Chief Emergency Medicine Santa Clara" is not an "individuals" of any kind... In is post, job position, occupational title, etc.
PSK wrote:
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

Customer's comments:

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, probably...
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 dictatorship as 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
PSK wrote:


However decisions 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.

Customer's comments:


3.1.  From 2009 said "treating provider" use to prescribe 100 day pills supply,  without problem... After that your Nurse Practitioner change his mind without any medical reasons. Maybe he got tapeworms from you?
3.2. "is not medically indicated"... How Nurse Practitioner knows???, if I not visited him since 2009 and not pass laboratory test since 2011.  And your Nurse Practitioner ever see me since???
3.3. Your Nurse 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 opinion...7
PSK wrote:


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.


Customer's comments:


4.1. How did you find that Great source!?
PSK wrote:


The Kaiser Permanente Member Issue Resolution Committee has recommended that you follow up with Mr. XXXXXXX at your earliest convenience


Customer's comments:


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"?.


PSK wrote:


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"

Customer's comments:


5.1. "... 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


5.2. That 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...


PSK wrote:


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.
Additionally, on 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 proper handling.

Customer's comments:


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?
PSK wrote:


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.

Customer's comments:


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 money...
B. Psychologist who can treat by using just Word...
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


PSK wrote:


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.


Customer's comments:


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


PSK wrote:


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

Customer's comments:


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?


PSK wrote:


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


Customer's comments:


8.3. I do know my rights and duties. I am son of criminal attorney at law and I was born not yesterday...


No thanks so far for you business style and behavior