Child Support / Medical Support – Uninsured Medical Expenses

In any divorce decree or order involving a child (order in suit affecting the parent child relationship such as a paternity decree), the order will contain medical support language.  As part and parcel of that language, found over about 4 pages all in lawyer langauge, are orders governing the uninsured portion of medical expenses.

Medical support language is contained in every divorce decree or order involving a childDallas Lawyer’s little talk about uninsured medical expenses in the context of the family law / divorce case.  Typical langauge will look like this:

• “If health-care expenses are incurred by using that HMO or PPO plan, Mom is ORDERED to pay 50 percent and Dad is ORDERED to pay 50 percent of all reasonable and necessary health-care expenses not paid by insurance and incurred by or on behalf of the children, including, without limitation, any copayments for office visits or prescription drugs, the yearly deductible, if any, and medical, surgical, prescription drug, mental health-care services, dental, eye care, ophthalmological, and orthodontic charges, for as long as child support is payable under the terms of this order.”

Typically, it is a 50/50 deal between the parents, but the order can assign other percentages as agreed to by the parties or as ordered by the court.  Note – the language addresses reasonable and necessary medical expenses.  Necessary expenses would not include, for example, teeth whitening. But notice the language above does include orthodontic.  At one time, orthodonic was considered “cosmetic” and not a part of reimburesed medical expenses.

The next portion of the order addresses the payment of the uninsured medical expenses and will look something like this:

• “IT IS ORDERED that the party who pays for a health-care expense on behalf of the children shall submit to the other party, within ten days of receiving them, all forms, receipts, bills, and explanations of benefits paid reflecting the uninsured portion of the health-care expenses the paying party incurs on behalf of the children. IT IS FURTHER ORDERED that, within ten days after the nonpaying party receives the explanation of benefits stating benefits paid, that party shall pay his or her share of the uninsured portion of the health-care expenses either by paying the health-care provider directly or by reimbursing the paying party for any advance payment exceeding the paying party’s share of the expenses.”

This simply means that the parent who took the child to the doctor, incurred a co-pay or uninsured portion of a medical bill must submit all forms and receipts associated with the medical treatment to the other parent for repayment of their 50% portion.  Okay, so Mom took child to the doctor. The child is checked out and Mom incurs a bill for $100.00.  She pays it.  Mom must submit her receipts to Dad within 10 days of incurring the bill.  This, in some order, maybe 15 days, 20 days, 30 days or some other number of days in which Mom is to submit the bill to Dad.  Dad then must pay Mom back within 10 days as set out in the order languaage above.  If Dad fails to pay Mom back within the 10 days, Dad can be brought before the court to show cause as to why he should not be held in contempt.

There are three possible scenarios that fall under this language:

• Mom submits the bills to Dad and Dad pays his 50% as ordered.

• Mom saves up the medical bills, does not submit them to Dad as Ordered and then after some great period of time submits them all at once and demands repayment.

• Mom submits the bills to Dad as ordered and Dad refuses to, or simply doesn’t, pay the medical bills.

First, talking about saving up medical bills.