Medical reimbursement request

[jcsct5]

State is CA.

Both parties are ordered to provide medical insurance on the minor children. My insurance is primary. Ex's is secondary. We are ordered to each pay 50% of reasonable uninsured health care costs.

I am in receipt of a medical reimbursement request from my ex. The amount requested includes over the counter products that could be used by anyone in the family, and costs for a prescription at full cost because ex chose not to go to one of the many covered pharmacies available to choose from. I had even discussed with ex, that same day, that Walgreens across the street from ex's house is a preferred pharmacy.

In California's Notice of Rights and Responsibilities Health Care Costs and Reimbursement Procedures, number 6 states that "If a parent provides health care insurance as ordered by the court, that insurance shall be used at all times to the extent that it is available for health care costs."

Number 7 states "If the court ordered coverage designates a preffered health care provider, that provider shall be used at all times consistent with the terms of the health insurance policy. When a party uses a health care provider other than the preferred provider, any health care costs that would have been paid by the preferred health provider had that provider been used shall be the sole reponsibility of the party incurring those costs."


1) Are pharmacies considered a "health care provider"?

2) If so since ex didn't go to a preferred provider pharmacy and did not use the child's primary insurance (or secondary) at all, am I responsible for only half of what the cost would have been had ex used the insurance (I am referring to numbers 6 & 7 above)?

3) Are over the counter medical items, such as hydrogen peroxide, band-aids, tylenol, etc. considered uninsured health care that is reimbursable?

4) If answer to number 3 is yes, then how would one determine what portion of an item that can be used by an entire family is deligated to the child?

Thanks.

[socrateaser]

>1) Are pharmacies considered a "health care provider"?

"Pharmacists" are health care providers. A Pharmacy is a retail store.

You are NOT responsible for over the counter medications unless prescribed by a state-licensed MD, OD, DDS., etc.

I.E., if a physician "prescribes" something (crutch, bandage, over-the-counter cough med), on a prescription pad, then you must pay 50%. Otherwise not.

Don't tell this to your ex -- he/she will ask the doctor to "prescribe" ibuprofin. Just refuse to pay anything unless accompanied by either an invoice from a healhcare provider, or a written prescription signed by the healthcare provider.

>
>2) If so since ex didn't go to a preferred provider pharmacy
>and did not use the child's primary insurance (or secondary)
>at all, am I responsible for only half of what the cost would
>have been had ex used the insurance (I am referring to numbers
>6 & 7 above)?

If ex obtained prescription meds which would have been less expensive at a preferred pharmacy, then you don't have to pay the difference. Over-the-counter meds are not your problem, regardless of where obtained, unless prescribed by a state-licensed physician.

>
>3) Are over the counter medical items, such as hydrogen
>peroxide, band-aids, tylenol, etc. considered uninsured health
>care that is reimbursable?

Depends. See above.

>
>4) If answer to number 3 is yes, then how would one determine
>what portion of an item that can be used by an entire family
>is deligated to the child?

Prescription + reasonableness. If parent purchases 100 asprin and the kid's got a flu for a week, then that's 28 pills, not 100. If kid's got arterialsclerosis and needs one pill a day for the rest of his/her life, then that's as many pills as would last until the kid's 18 years old and graduated high school (or 19 years old, whichever occurs first).