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Dear Advocate…
Deducting out of pocket medical expenses from the share of cost?


Dear Advocate:

My father is in a skilled nursing facility and from time to time he has extra medical needs that he can not pay for because he only has $35.00 left each month after he pays his share of cost. I was told that if I could get the physician to write a prescription that I could deduct these expenses from his share of cost. Unfortunately the attending physician is not being cooperative and will not write a prescription to include it in his plan of care. Is there anything that can be done about this? I can no longer afford to keep up with these out of pocket costs.

Sincerely,
Bemoaned in Berkley

Dear Bemoaned,

You are correct; your father may use his share of cost to pay for medical expenses not covered by Medi-Cal. This right is provided by a California lawsuit settlement, Johnson v Rank. Under this settlement, Medi-Cal recipients may use their share of cost to pay for medically necessary supplies, equipment or services not covered under the Medi-Cal program. A current physician's prescription is necessary and must be a part of the physician's plan of care. If the physician is being uncooperative and will not write a prescription, your father is entitled to the health care provider/attending physician of his choice (42 C.F.R. §483.10(d)(1)), and is entitled to receive medical, dental remedial care services, supplies and /or equipment from such providers, even if they are not a part of or affiliated with the facility. In addition he has the right to purchase drugs, from a pharmacy or medical supplier of choice (H&S Code §1320; 22 CCR §72527(a)(22)).

Page Last Modified: March 11, 2013