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Unreimbursed Medical Expenses – Deadline Fast Approaching!

Posted by Ted Hoppe | Mar 23, 2016 | 0 Comments

If you receive child support you probably know that your child support Order covers how medical expenses for your children are to be paid.  However, there is sometimes confusion about how unreimbursed medical expenses get paid and how much each parent is responsible for.

Health Insurance/Premiums – Generally that the payor (usually the parent who does not have primary custody or, in cases of shared custody, the parent who makes more money) provides the health insurance for the children.  Often, though, it is the parent who either has insurance, has the better insurance, or has the less expensive insurance that provides the insurance for the children.  Adjustments are made to the basic child support amount for each parent's share of the premiums for the health insurance for the children.

Unreimbursed Medical Expenses – Initial Payment – The guidelines provide that the custodial parent/the parent receiving support is responsible for the first $250.00 in unreimbursed medical expenses per child per year.  In other words, if you are receiving support, you are responsible for paying any out of pocket expenses for your children up to $250.00 per child per year.  The expenses are calculated on a calendar year (January through December) basis regardless of when the support Order is entered.

What happens once the initial $250.00 is paid? – Any unreimbursed medical expenses that are incurred in excess of the $250.00 per year per child are paid by the parties based on the percentages set forth in the support Order.  These percentages are determined based on how much each parent earns in relation to the total combined income.

What medical expenses are eligible for reimbursement? – It is important to know that not all medical expenses are eligible for reimbursement.  The Support Rules state that medical expenses include “insurance co-payments and deductibles and all expenses incurred for reasonably necessary medical services and supplies, including, but not limited to surgical, dental and optical services, and orthodontia”.

The following items are NOT included as unreimbursed medical expenses unless ordered by the Court or agreed by the parties:  “cosmetic, chiropractic, psychiatric, psychological or other services. . .”.   This will often come up as an issue if a child is going to counseling related to the parent's separation/divorce.  This counseling is not eligible for reimbursement unless the Court orders it or both parents agree.  If you have a child in counseling, be sure to have counseling including in the order as an expense subject to reimbursement.

What are reasonably necessary medical services and supplies? – There is no guidance in the Rules about what constitutes “reasonably necessary medical services and supplies” and, unfortunately, the issue usually does not get raised until you submit a request for reimbursement.  To avoid any conflicts about whether medical treatment was reasonably necessary, it is important to keep the other parent informed about what it going on.  Make sure they know when the doctor's appointment is and that they have the contact information for the doctor.  If a procedure is scheduled, make sure they know what it is and when it will be performed.  This gives them the chance to object in advance and to talk with the doctor before the procedure.  Also, make sure that the services/supplies are being prescribed by the doctor and that you have it in writing.

One area where this sometimes comes up is with braces.  Even though orthodontia is listed as a covered expense, sometimes a parent will question whether it is reasonably necessary for the child to have braces or if it is being done purely for cosmetic purposes.  This is especially true if it is a second set of braces.

How do I get reimbursed? – The rules require two things for you to be reimbursed for eligible expenses.  First, you must provide the other parent with documentation of the expenses.  I recommend that you do a spreadsheet showing the expenses, the deductions of the $250.00 and then the calculation of each parent's share.  You should attach copies of the receipts to the spreadsheet. The rules do not say how the documentation has to be provided, but you want to have proof that you did provide it.  You can send it certified mail, return receipt requested, email or fax.  I do not recommend hand delivering unless you get a receipt because you cannot provide that you provided it.

Second, the documentation must be provided by March 31 for the prior year. If you do not provide the documentation by March 31, it is up to the discretion of the court whether you will receive the reimbursement.

About the Author

Ted Hoppe

Hi, my name is Ted Hoppe and I have been an attorney in Pennsylvania for more than 25 years. In my practice, I focus on helping businesses and families with legal issues that affect them. Because I am knowledgeable and experienced on a variety of legal matters, I have built many long-term relatio...

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