How are Health Care Expenses not Covered by Insurance Paid and Reimbursed in a Paternity, Legal Separation or Divorce in 2014 in San Diego?

In a child support order, in San Diego, there are additional costs which are in addition to the base guideline amount. In the base guideline amount, the cost of the insurance premium is included in the calculation and this is not divided or reimbursable. Costs such as uncovered, unreimbursed medical, counseling, dental, vision and orthodontic are included in these additional costs.

The procedure is to make payment within thirty days of receipt of the cost. Payment with a check or credit card, for documentation purposes, if preferred over cash. Payment should be made directly to the provider with a copy of the statement showing the invoice. A file should be kept in a safe place for all of these receipts. Demand for reimbursement should be made within thirty days of making the payment. Insurance coverage needs to be used whenever available. There is a presumption rebuttable] that the cost actually paid for any uninsured health care needs of the child or children are reasonable, however, as with many legal issues, there are exceptions and qualifications. The qualification require that the parents utilize the insurance coverage provided by a parent pursuant to court order, as above, unless the other parent can show that the insurance coverage for health care is not adequate to meet the child or children’s needs.

Upon receipt of the payment, the other parent has thirty days to reimburse under California Family Law Code Section 4063. The payment should be by check and should reference [on the memo section of the check] the exact reimbursement payment to avoid later arguments over what was reimbursed and what was not reimbursed. If a dispute arises regarding whether the reimbursement is in accord with the law, a hearing may need to be held depending {of course} on the amount in controversy. Going to court over a $10 copay when each party owes $5 would be not an appropriate motion.

Disputes may arise in many contexts. One example is when the custodial parent does not approve of the medical insurance coverage provided by the other parent. This can, for example, that the form of an HMO which is very restrictive. The California State Legislature's intent is clear. If one parent is court ordered to provide insurance that would have provided treatment and the other parent does not use the coverage, then the party who did not use the coverage should pay 100% of the cost of the uncovered treatment unless there are extraordinary circumstances. The burden is on the parent who fails to utilize the insurance coverage to show why it was inadequate. Another example is when a child or children are taken to what are referred to as "alternative" health care providers: acupuncturists; herbalists etc. In this case, will the other parent be liable for a contribution of 50% if the expenses are not "legitimate medical" expenses? In this example, the presumption will be that the costs paid for the uninsured health care needs of the child or children are reasonable. As such, the burden is on the parent who is objecting to establish that they are not reasonable medical expenses.

The Law Firm of Doppelt and Forney, APLC has experience with medical reimbursement issues as well as other family law issues. A free and complimentary virtual consultation will help you make the most informed and intelligent decisions for your case and allow you to see if the attorney and law firm are right for you.