Obtaining reimbursement of uncovered medical bills

Posted Monday, July 27th, 2015 by Gregory Forman
Filed under Child Support, Contempt/Enforcement of Orders, Litigation Strategy, Of Interest to Family Court Litigants, Of Interest to Family Law Attorneys, South Carolina Specific

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.

12 thoughts on Obtaining reimbursement of uncovered medical bills

  1. Jordan says:

    Great overview here. It’s important to understand medical reimbursement like this. Thanks for sharing!

  2. Jeffrey Bryant says:

    My wife has been scanning and sending a balance to her ex through her attorney to his attorney, and he still makes no effort to repay. You can spell it out to the penny and still nothing. He denied certified mail twice so this is the last resort, yet our attorney will not hold him accountable. He owed her money at time of their divorce of uncovered accrued up to their divorce, and was ordered to pay her back on a payment plan and paid two times then nothing for 9 months until his mother paid it. Now nearly two years since divorce he has racked up more unpaid medical and hasn’t paid a dime towards the balance. She has handed the bills to him and he even gets the EOBs himself, and she has a updated excel sheet and scans every receipt and medication prescribed, and texts him each time her son visits the doctor and our lawyer is twiddling their thumbs. Order says he has 15 days to repay her from time of receiving proper documentation, yet that order means nothing to him and our lawyer will not file rule to show cause

    1. I can’t tell why her attorney won’t file a rule to show cause but she might seek a second opinion.

  3. Poppy James says:

    Question: I have been giving my ex husband a copy of the bills as well as a copy of my credit card statement (with my credit card number blacked out) to show proof they were paid since the judge made his ruling to do so 6 months ago. He has paid it up until now. He is now requesting a copy of my credit card as well as the numbers un-blacked out so he can see that I was the one that paid. Our agreement states “Respondent (him) shall pay for 1/2 of uninsured health care costs. Petitioner (me) shall provide a record of medical bills to Respondent by email.” Am I required to give him my credit card and un-black out the numbers on my statement? The bills and the credit card statement should be enough proof, no?

  4. Reese says:

    Poppy James: Why don’t you just show the first three or last three of your credit card number and same on statement? But if your name is on the statement that should be enough. Otherwise next your ex will be asking for proof that no one else reimbursed you later on.

  5. Raymond says:

    Per court order I (NCP) was ordered to provide health insurance for our son and to reimburse my ex half on all out of pocket medical expenses not covered by our insurance. My ex was never ordered to provide insurance. The order states that she has 30 days upon receipt to mail me copies of the receipts and then I have 30 days to reimburse her. For the past 3 years she has taken our son to numerous doctors, specialist and er visits without informing me before doing so, without my consent on surgeries and out of network specialist.. Within 2 years our son has been seen by a medical professional 100 + times and some years I pay more for out of pocket medical expenses than I do for a years worth of CS. She refuses to send me proof of his medical summaries or any other information. She tells me to figure it out since I have J.C. Up until last year I would receive statements in the mail from my insurance and from there I was able to figure out where she was taking our son to be seen. She would mail me her invoice along with receipts and I always reimbursed her in full by personal check. All of a sudden I stopped receiving statements from my insurance through the mail even tho I knew our son was going to the doctors because he would tell me. Whenever I would ask questions or if she withheld my visit due to the “sick” visit (atleast once a month and every single holiday), I would request for the doc’s name and proof of visits etc. She refused and told me to figure it out since I have J.C. After figuring out where she was taking our son to, I started calling around. Most offices wouldn’t speak to me because I was “not authorized.” Eventually one lady let it slip that my last name was not the same as the one that they had in their records. Somehow my ex had my last name changed to her last name to keep them from speaking to me. After providing proof to the billing department that I have J.C. they reveled to me that my ex had my mailing address changed to hers and that she specifically told them that they were not to speak to me.

    On top of that I have numerous emails where she claims that she made payments for glasses, medications and co-pays but keeps refusing to provide me with proof within 30 days so that I can reimburse her. Our son would come over and say look at my new hearing aid/glasses. I would email her asking as to why she never informed me of the appointment or consult with me on special services/diagnoses/ purchases, she would get mad and tell me to figure it out, that she was doing it regardless if I liked it or not or that she doesn’t have to include me. I have sent her numerous emails questioning why she hasn’t sent receipts/summaries/notes etc. to me per our c.o. Then all of a sudden she finally sends me some of the old receipts but on her invoice she has those old receipts listed as “RAYMOND’S PAST DUE AMOUNT” I emailed her and explained to her that I see how she is trying to make all of this appear in her favor for when I take her to court and that I will forward her emails back to her where she has repetitively refused to provide me prof of purchases. If the court was to look at her proof without reading our emails, then she would clearly be in the right. (she mailed proof of purchase and I received it on 1/5/2016 and the receipts were dated for ex: 1/1/2015 and listed on her invoice as “Raymond’s past due”. Without reading the emails someone may assume that I have refused to reimburse this expense for a year. When in fact I have emails to back up my story. I am currently trying to get all evidence together to take her to court. Thanks

  6. Sue says:

    My husbands ex is asking him to pay 1/2 of orthodontist bills. He received a copy of the financial contract from the dr office and she is not listed as the financial party for the services, her mother is listed and her mother signed the contract. Also she could not use her dental insurance since her mother is the financial party and not listed as the insurance carrier. Also joint legal custody and no notification of orthodontist needed. Does he have to reimburse her mother??

  7. Michelle says:

    Quick question–what would a custodial parent need to provide in court as a medical receipt? We are not receiving original receipts from the doctor with the child’s name on it. Would a receipt from a creditor with amount but only child’s name handwritten at the top be admissible in court? Also, we have received numerous “partial” receipts with pages missing and the total charges not adding up. Is that admissible in court? Any advice you can give on what the actual receipts must include would be so helpful!

  8. JCC says:

    Poppy James: I’m not a lawyer so I usually refrain from responding. Hopefully a lawyer will chime in here but I do not think it matters who actually pays the costs, only that the costs were in fact incurred for the child. If you can prove that the treatment was for your child and substantiate that the costs were associated with that treatment, it doesn’t even matter who actually paid your portion of the cost. Hence, providing your credit card statement should not be required. Nothing changes the fact that the other parent is responsible for his/her portion of your child’s medical costs. Using the same logic, it wouldn’t matter if your ex’s mother or current girlfriend, etc. gave him the money to pay you for those expenses.

  9. Rhonda Rogers says:

    How did calculate this on the child support calculator when we just decided this, and I have been paying for my daughters therapy, since Feb. then last week after we made agreement, he to start paying himself. This is also only over around 6 months, willl they put those figures in our final for child support on each side of the column, she. It permanent. If so , what to they use when one party is 75% and other 25#

  10. Leo Landry says:

    I have a question. Here’s the situation
    A divorce couple have shared cost in medical. The grandparents of the father decide to get braces for the children as a gift and they pay for it without notifying the mother. Now the father sends a bill to the mother 7 years later asking for the mother to pay half of the costs. She had 50% medical decision making but was never notified or involved with this treatment and the father never spent a dime of his own money on their children.
    Does the mother owe this money ?

  11. Allie says:

    An ex wife is trying to take her ex husband back to court stating that because their son has mild ADHD that his private tutor is considered “uninsured medical expenses” and that the ex husband pay 80% and her only 20%. She demands the child go 2x a week adding up to $800 a month. The public school system has said the child does not qualify for a special edcuation plan. So how can she claim it is an unisnured medical expense? Will a judge in SC rule in her favor? How do you prove that a 9 year old child who lost 2 years of real schooling because of the pandemic needs tutoring because of that rather then his mild ADHD?

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