Obtaining reimbursement of uncovered medical bills

South Carolina’s child support guidelines include a provision for payment of unreimbursed medical expenses for the children. Per these guidelines:

The guidelines are based on the assumption that the parent to whom support is owed will be responsible for up to $250.00 per year per child in uninsured medical expenses. The Schedule of Basic Child Support Obligations includes $250 per child per year for uninsured medical expenses such as co-pays, over-the-counter medicines and similar expenses. Reasonable and necessary unreimbursed medical expenses in excess of this $250 per child per year shall be divided in pro rata percentages based on the proportional share of combined monthly adjusted gross income. The determination of “reasonable and necessary”, e.g. orthodontia and professional counseling, would be at the discretion of the court.

Most South Carolina child support order reflect this language, with the custodial parent being responsible for the first $250 per child per year for unreimbursed medical expenses and the other parent then being responsible for his or her pro rata income share. Ideally the child support order reflects a fixed percentage, rather than using the “pro rata” language. This blog assumes the order sets a fixed percentage. If it does not, then the issue of the parties’ respective incomes, and pro rata shares, also needs to be resolves before reimbursement can be accomplished.

There are numerous common problems in enforcing these orders, through a contempt action/rule to show cause, and obtaining medical reimbursement when the other party refuses to pay his or her share. Among the common problems are:

• The custodial parent failed to provide the other parent proof of any unreimbursed expenses before filing a rule to show cause
• The custodial parent failed to provide the other parent proof of $250 per child per year in unreimbursed expenses before filing a rule to show cause to collect reimbursement of a portion of the remaining amount
• The custodial parent failed to demonstrate that he or she provided the other party evidence of the unreimbursed medical expenses and a request for reimbursement before pursuing a rule to show cause
• The custodial parent failed to provide the other parent sufficient time to pay his or her share of any unreimbursed expenses before filing a rule to show cause

These first two issues are problems because one needs to prove the existence of the obligation before one will be awarded reimbursement. The final two issues are problems because even when the obligation exists, the other party will not be held in contempt–and therefore will be unlikely to be required to pay the custodial parent’s attorney’s fees for collection and enforcement–if the custodial parent cannot prove he or she sought first sought reimbursement and gave the other party a reasonable time to comply.

There are set procedures one can use to obtain medical reimbursement and maximize the chances of being awarded attorney’s fees if one has to bring a contempt action to obtain reimbursement. These procedures require the use of a scanner and email. Any custodial parent who will be seeking medical reimbursement is advised to invest in these items. The custodial parent should provide proof of medical expenses for the child or children, via email, on at least a quarterly basis (unless the parties’ order requires more frequent proof). The medical bills and proof of payment should be scanned and emailed to the other parent even if reimbursement is not yet required. Often non custodial parents will claim that proof of payment is not proof of unreimbursed medical bills because there may be insurance reimbursement. Generally this claim is specious: office co-pays are not reimbursed and prescription medication expenses typically reflect the actual out of pocket cost. However if the custodial parent gets Explanation of Benefits (EOB’s) from the insurance company those should also be provide.

Attached to this email should be a separate spreadsheet for each child showing the date of the medical treatment, the uncovered portion of the bill, the amount the custodial parent paid (if different from the uncovered portion), the medical treatment that created this bill (to demonstrate that this treatment was medical necessary), and the running total of unreimbursed medical expenses for that child for that calendar year.

Within the body of the email should be an explanation of the amount each child has incurred in unreimbursed medical expenses for the calendar year and a calculation of the other parent’s share of this obligation (typically the amount of expenses to date, minus $250, multiplied by the other parent’s share). Finally the email should note the amount the non custodial parent has already paid for that child’s unreimbursed expenses for that calendar year. That figure should be deducted from the previous calculation and this amount becomes the amount the other parent owes.

Typically one should offer the other parent 30 days to pay his or her portion (unless the court order sets a different deadline). If the amount of obligation is greater than the other parent’s typical monthly child support obligation one might offer a payment plan on the balance.

Finally the custodial parent should save these reimbursement demands, and any responses from the other parent, in a designated file folder (I like to name the folder “medical reimbursement”) within the email program that parent uses. Should one need to retain counsel to obtain reimbursement, the contents of this folder are vital to proving the other parent has received actual notice of the amount he or she owes, has been provided sufficient documentation to demonstrate this entitlement, and has been provided a reasonable time to comply.

Sometimes the content of this folder might demonstrate difficulties in pursuing contempt. Perhaps there is a legitimate dispute over whether a bill is medically necessary, whether the amount of unreimbursed expenses being claimed is accurate, or whether the other parent has been given reasonable time to comply. It might be advisable to provide the other parent additional evidence of expenses or medical necessity before pursing contempt, to offer a compromise on disputed issues, to give the other parent a longer time to pay the reimbursement, or to forgo certain reimbursement claims in pursing the contempt. Having all these communications in writing and easily accessible allows an attorney to advice a custodial parent on how to address these issues prior to filing a rule to show cause.

Hiring an attorney for a medical reimbursement claim does the custodial parent no good if that client ultimately spends more money on attorney’s fees than he or she obtains in medical reimbursement. Thus, maximizing the chances that the other parent will be found in contempt for non compliance, and thus likely ordered to reimburse fees, is vital to making claims for medical reimbursement worthwhile. Following the above procedures maximizes the likelihood that one will successfully obtain reimbursement and will be awarded fees for bringing a contempt proceeding for medical reimbursement collection.

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