Uninsured Medical Expenses and Child Support

It's unavoidable that all children need medical care. The primary purpose for any family law matter is to ensure the child's best interests are met.

So, in addition to basic child support obligations, a court orders parents to provide medical support for their child's health care. That can include enrollment in health insurance coverage and paying insurance premiums.

The court may order the obligor parent with insurance to keep the insurance as long as the coverage is available for the minor child. The coverage for the child is either a no-cost add-on or a reasonable cost. They can order a party to maintain health insurance in addition to the child support amount.

If a parent pays out-of-pocket for an insurance policy, the court may give them an allowance when calculating the child support amount. The cost of health insurance factors into the final support award. But what about when the insurance policy does not cover all the child's medical expenses? How does the court account for that? Read on to learn about child support and uninsured medical expenses.

Parents' Responsibility for Uninsured Medical Expenses

Parents must pay for the uninsured or unreimbursed medical expenses of their child. Uninsured medical expenses are those expenses that insurance does not cover, including:

  • Co-pays
  • Deductibles
  • Prescriptions
  • Other health care expenses, such as dental expenses/dental insurance and vision expenses/vision insurance. This includes out-of-pocket costs from medically necessary treatments or procedures.

These out-of-pocket medical costs are "extraordinary" medical expenses. They are more than the cost of basic health care included under a parent's health insurance plan.

Most child support orders provide the percentage of uninsured and unreimbursed medical expenses each party is responsible for paying.

If your child support order does not state how to deal with uninsured medical expenses, you may want to change an existing child support order. For example, say the pediatrician diagnosed your child with special health care needs. The current care coverage is inadequate for her "special needs." Medicaid only covers some of those needs. You could ask a judge to change the child support amount because of the changed circumstances.

State Guidelines for Uninsured Medical Expenses

States have child support guidelines that address the handling of a child's medical expenses. Here are some options for uninsured medical expenses:

  • Parents share the costs outright based on a proportion of their monthly income. This follows the "income shares model."
  • Parents share the cost when the amount equals more than a certain percentage of the original child support payment.
  • The noncustodial parent pays after the custodial parent pays a specific dollar amount.

Some states distinguish between non-recurring and recurring health care costs. These states also force parents to share the cost of only unpredictable non-recurring health care costs based on their income percentage level. Check the child support laws of your particular state to see how they manage uninsured medical expenses in your case.

Collecting Unpaid or Unreimbursed Medical Expenses

You may encounter several issues when you try to collect from your co-parent your child's out-of-pocket medical bills. Oftentimes a child custody and support order may not be clear on the process for the parents' division of out-of-pocket health care costs of the child. It may provide a percentage split, but little else. The outcome may depend on a few variables, such as:

  • Timing
  • Notice
  • Reasonableness

If the parties agreed on a process in their decree, they need to follow the directives of the decree. If the parties did not agree and the court issued the decree after a hearing or trial, they must review the decree for any specific process.

In any circumstance, the parent making such a request will most often contact the other parent and ask them to pay. They usually need to do so within a reasonable period from the date of incurring the expense. The parent seeking reimbursement may provide evidence of the bill and payment they already made. The parent who owes should reimburse their share within a reasonable time.

What happens if parents disagree over whether a medical service is necessary? For example, they may disagree on whether a child needs to see a physician after the first sign of a cold. A court may consider the reasonableness of the medical service to determine whether the parents should split the payment.

Payment Procedures

States provide various forms of payment procedures:

  • Noncustodial parents must pay their share directly to the custodial parent.
  • Noncustodial parents can pay either to the other parent or to a health care provider directly.
  • Noncustodial parents must pay a health care provider or child support agency directly.

In all cases, parents may use the following tips when attempting to collect unreimbursed or uninsured medical expenses:

  • Retain any health care bill of the child and explanation of benefits statement (EOB) from the insurance company. Document the date and the provider of treatment services.
  • Retain proof of payment, including receipts, bank statements, checks, and any other financial records that are relevant to such medical expenses.
  • Make copies of bills and receipts for your records.
  • Provide written notice to the other parent (including copies of relevant documents). Demand reimbursement in writing in an agreed-upon number of days or otherwise reasonable timeframe.
  • Reach out to the other parent informally as well.
  • Follow all child support procedures outlined in the original child support agreement.

Enforcing Unpaid or Unreimbursed Medical Expenses

Suppose the parent responsible for providing medical support payments set out in the order fails to make those payments. The custodial parent may request that the local child support enforcement agency consider bringing a civil contempt action as they would for non-payment of child support.

Suppose the parent responsible for payment fails to make reimbursement within a timeframe required by the parents' arrangement of relevant out-of-pocket health care expenses. The custodial parent can initiate enforcement actions. Failing to pay for unpaid or unreimbursed medical expenses may result in contempt of court proceedings. These proceedings are similar to the civil contempt of court brought by the child support enforcement agency for non-payment of child support or "arrearages."

Get Clarity on Uninsured Medical Expenses: Talk to a Lawyer

A child's uninsured (or underinsured) medical expenses can add up quickly, leaving parents scrambling to pay the bills. Even if you already pay monthly child support, you may still be on the hook for these additional expenses. But laws vary by state. Meet with an experienced family law attorney near you to get more insight into your child support obligations.

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Can I Solve This on My Own or Do I Need an Attorney?

  • Some states allow you to set up child support with forms and court processes
  • You may need legal help to set up or modify child support arrangements
  • If there is conflict, an attorney can advise if the other parent’s actions are legal 

Get tailored advice about paying or receiving child support. Many attorneys offer free consultations.

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Don't Forget About Estate Planning

Once new child support arrangements are in place, it’s an ideal time to create or change your estate planning forms. Take the time to add new beneficiaries to your will and name a guardian for any minor children. Consider creating a financial power of attorney so your agent can pay bills and make sure your children are provided for. A health care directive explains your health care decisions and takes the decision-making burden off your children when they become adults.

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