Uninsured Health Care Costs
Divorce Lawyer in Covina
In addition to basic child support costs, parents are required to pay for uninsured or unreimbursed medical expenses, or health care services not covered by insurance. This includes co-pays, deductibles, prescriptions, and any other cost incurred as a result of necessary medical treatments or procedures. Uninsured health costs are addressed in California Family Code section 4063 which states that:
- The court should advise each parent, in writing or on the record, of his or her rights and liabilities, including financial responsibilities
- The court should include in its order the time period for reimbursement of additional child support costs subject to the requirements of this section
If a parent paid excessive uninsured heath care costs, he or she must provide the other parent with an itemized statement of the costs within a reasonable time, but not more than 30 days after accruing the costs. These costs shall then be paid as follows:
- If a parent has already paid all of these costs, that parent shall provide proof of payment and a request for reimbursement of his or her court-ordered share to the other parent.
- If a parent has paid his or her court-ordered share of the costs only, that parent shall provide proof of payment to the other parent, request the other parent to pay the remainder of the costs directly to the provider, and provide the reimbursing parent with any necessary information about how to make the payment to the provider.
- The other parent shall make the reimbursement or pay the remaining costs within the time period specified by the court. If no period is specified, they should pay it back within a reasonable time not to exceed 30 days from notification of the amount due, or according to any payment schedule set by the health care provider for either parent unless the parties agree in writing to another payment schedule or the court finds good cause for setting another payment schedule.
If the reimbursing parent disputes a request for payment, that parent shall pay the requested amount and thereafter may seek judicial relief. If the reimbursing parent fails to pay the other parent as required, the other parent may seek judicial relief.
Either parent may file a noticed motion to enforce an order issued. In addition to the court's powers under Section 290, the court may award filing costs and reasonable attorney's fees if it finds that either party acted without reasonable cause regarding his or her obligations pursuant to this section.
There is a rebuttable presumption that the costs actually paid for the uninsured health care needs of the children are reasonable, except if:
- The health care insurance coverage, including, but not limited to, coverage for emergency treatment, provided by a parent pursuant to a court order, shall be the coverage to be utilized at all times, consistent with the requirements of that coverage, unless the other parent can show that the health care insurance coverage is inadequate to meet the child's needs.
- If either parent obtains health care insurance coverage in addition to that provided pursuant to the court order, that parent shall bear sole financial responsibility for the costs of that additional coverage and the costs of any care or treatment obtained pursuant thereto in excess of the costs that would have been incurred under the health care insurance coverage provided for in the court order.
- If the health care insurance coverage provided by a parent pursuant to a court order designates a preferred health care provider, that preferred provider shall be used at all times, consistent with the terms and requirements of that coverage.
- If either parent uses a health care provider other than the preferred provider inconsistent with the terms and requirements of the court-ordered health care insurance coverage, the parent obtaining that care shall bear the sole responsibility for any non-reimbursable health care costs in excess of the costs that would have been incurred under the court-ordered health care insurance coverage had the preferred provider been used.
When ruling on a motion made pursuant to this section, in order to ensure that the health care needs of the child under this section are met, the court shall consider all relevant facts, including, but not limited to:
- The geographic access and reasonable availability of necessary health care for the child which complies with the terms of the health care insurance coverage paid for by either parent pursuant to a court order
- The necessity of emergency medical treatment that may have precluded the use of the health care insurance, or the preferred health care provider required under the insurance, provided by either parent pursuant to a court order
- The special medical needs of the child
- The reasonable inability of a parent to pay the full amount of reimbursement within a 30-day period and the resulting necessity for a court-ordered payment schedule
The essence of California Family Code section 4063 is that if either party incurs a medical expense not covered by insurance, the party incurring the expense must send confirmation of payment to the other parent whereby there is an expectation of re-payment within 30 days. Again, although a greater time may be allotted, the norm is a 30 day window for which to send these expenses to the other parent and an additional 30 days for which any amount incurred should be paid. The court does not want a parent holding receipts for an inordinate period of time and then sandbagging the other parent with a huge medical bill.
In addition to timing, please keep in mind that the above code section does not apply to such luxury items. For example, braces, which are not mandatory, may not be reimbursed, particularly if one parent does not agree to incur the cost for such an expense.
Finally, if insurance is available, but a parent opts to not utilize the insurance or obtain services from an out-of-network provider, then that parent may be solely responsible for the cost incurred and cannot request reimbursement from the other parent.
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If you’re being targeted with extraneous medical costs, or your ex has refused to reimburse you for uninsured child health care, contact us as soon as possible. Our experienced Covina divorce attorney has worked for many years assisting people pre- and post-divorce. We understand how difficult managing separate lives is, so trust us to represent you in negotiations and in court.
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