Ninth Judicial Circuit Court
FRIEND OF THE COURT HANDBOOK - MEDICAL SUPPORT
Payment of Health Care Expenses
Each child support order issued or modified after October 1, 2004 will include an additional amount for "ordinary health care expenses". A person who pays support will pay an additional amount to cover a portion of the child(ren)'s ordinary health care expenses. To pay out-of-pocket health care expenses as they are incurred will eliminate the need to seek separate reimbursement for every routine health care bill.
"Ordinary health care expenses" include co-payments, deductibles, and other uninsured health care costs. The base support obligation already covers remedial care items (i.e. band aids and non-prescription drugs) so these are not included in this category. On average, parents spend $345 annually per child on ordinary health care costs.
Unless otherwise provided in the court order, the parent with physical custody has the responsibility to make decisions regarding routine medical care of the child, such as: choice of doctors, nature and extent of care, and the timing of non-emergency care, including the scheduling of periodic physical examinations. However, in cases where joint legal custody has been awarded, the parent with physical custody must consult with the other parent on major decisions such as surgery, hospitalization, or orthodontic work. In emergency situations involving the minor child, the non-custodial parent must be informed immediately.
Unless specified in the court order, specialized courses of treatment may require a separate court order, which states the responsibilities of the parties to pay for the treatment. Health care expenses above the ordinary health care amount in the order are "extraordinary" health care expenses. Any health care expense incurred by the payer of support is also considered an extraordinary health care expense. The support order will tell the parents the percentage that each must pay for extraordinary health care expenses. Parents are cautioned that providers of medical care are not required to look for payment to any person other than the parent who authorized the treatment. That parent must then ask for reimbursement from the other parent.
Rules For the Parents about Health Care Expenses
- Both parents are responsible.
- Parents who are required to pay support contribute their share or ordinary expenses as part of their regular child support payments. Custodial parents usually contribute their share by paying the health care provider directly.
- The amount specified in the court order is for all the children in the case. Parents do not have to keep a separate accounting for each child.
- The amount in the order restarts at the beginning of every calendar year (January 1st to December 31st).
- The custodial parent can only request medical enforcement from the FOC if the ordinary health care expenses exceed the amount in the court order.
- If the payer incurs a health care expense for the child(ren), that parent can request medical enforcement assistance from the FOC.
General guidelines for the payment of health care expenses by the parties are as follows:
- A parent is required to provide health insurance information to the other parent, and a copy, when requested, to the Medical Support unit of the FOC office. The parents and each parents' employer may receive inquiries from the FOC office for information about the insurance maintained for the children.
- The parties are required to submit expenses to all available insurance companies to keep out-of-pocket costs to the parties to a minimum. Each parent's liability is determined by their court ordered percentage of the balance remaining after the subtraction of all insurance reimbursements for the medical expense, from all sources (insurance from parents, step-parents, grandparents, etc.).
- The parent obtaining health care for their children is responsible or giving the health care provider information regarding all insurances (medical, dental, vision, etc.) and stating which insurance company is primary to assist in proper billing of the expense. The parent obtaining care for the children is the responsible parent for payment, even if they do not have insurance or their insurance is not the primary provider.
- The custodial parent should keep track of health care expenses they incur in case they exceed the amount stated in the order. To seek enforcement for "extraordinary expenses" the custodial parent must provide documentation that they exceeded the ordinary health care amount in the order.
A parent must provide a copy of the "extraordinary" medical bill to the other parent within 28 days after the insurer's final payment or denial of coverage. To clearly show the amounts paid/due from each party (including paid by insurance). We recommend that parents use form FOC 13 Request for Healthcare Expense Payment which includes the following information:
The parents must cooperate in the payment of the bill in order to satisfy their joint liability.
- The child's name
- Date of service
- Nature of the services performed
- Cost of service
- Complete name (address) of the health care provider
- An explanation of benefits (if available)
- Amount remaining to be paid.
- Payments on medical bills should not be sent to the FOC for disbursement except as detailed below (see Enforcement of Medical Expenses). The FOC does not act as a clearinghouse for the payment of medical bills. These matters can and should be handled directly by the parties themselves, in the majority of cases.
- All insurance payments are to be forwarded to the health care provider or to the parent who incurred the expense.
Enforcement of Medical Expenses by the FOC
The law requires the FOC to enforce the medical support provisions of your support order.
Before a complaint of non-payment will be accepted by the FOC you must first provide, within 28
days after the insurer's final payment or denial of coverage, the other parent with an itemized
statement for each expense (see item 4 reference to form FOC 13). This statement needs to include the name of the child that received care, the date of the care, the reason and diagnostic code and cost, and the complete name and address of the health care provider. If applicable, a copy of your insurance carrier's explanation of benefits (the statement that tells why the insurance did or did not pay towards the expense and the amount paid) should be included.
If the other parent does not pay their share of the claimed expenses with 28 days of the date you
provided the itemized statement to that parent, then you may file a written request for enforcement
with the FOC. To file a non-payment complaint with the FOC, provide a copy of your FOC 13 Request
for Healthcare Expense Payment form and all the attachments (see #4 in the Guidelines for Payment).
In addition, completion of a Complaint For Enforcement of Health Care Expense Payment (form FOC 13a)
will be required. A complaint must be submitted to the FOC on or before any of the following:
a. One year after the expense was incurred.
b. Six months after the insurers' final payment or denial of coverage for the expense.
You will also be required to attend all appointments, conferences and hearing about the bills and to produce a copy of an itemized bill for each expense, receipts showing any payments made and any related correspondence with the provider of service or the other parent. These documents are needed to prove your case. After verifying that the ordinary health care amount has been exceeded and that the process of the law has been followed, the FOC will send the formal request for payment to the other parent. If the parent does not pay the bill or object and request a hearing, the amount will be added as a support arrearage to your case, or credited to the support balance.
A party also has the option of initiating an enforcement action through a private attorney.
The FOC makes no distinction between parents who receive support and parents who pay support when processing health care bills for children. These are shared responsibilities unless your order says otherwise. If you have paid for health care bills for your children, you can use the enforcement processes of the FOC even if you are the person who pays child support.
Health Care Insurance
Provisions requiring one or both parents to maintain health insurance for the child(ren), if such insurance is available through a parent's employment, are required in the following:
- Judgments of Divorce involving a child
- Orders involving a child of unmarried or separated parents.
- Modifications to existing judgments and orders.
If your order requires you to maintain health insurance for your child(ren) and it is available through your employer, you must provide such coverage even if you have to pay a premium, provided that the premium is determined to be a "reasonable cost" under the provisions of Michigan State and Federal law. If the amount being paid for child support, childcare and your portion of the health care premium exceeds 50% (in some cases 55%, 60% or 65%) of your wages after taxes, union dues and/or uniform charges, the cost is considered unreasonable.
If coverage is not maintained through parent's employer and coverage is available, a National Medical Support Notice (NMSN) will be forwarded to the employer with a copy to each parent. The NMSN requires the employer to enroll the children listed on the form for all insurance types available. If the cost is available they must provide it, along with information regarding the coverage to the FOC.
If the employer determines that the employee's wages do not allow the enrollment of the children on
the available insurance, the employer must provide documentation to the FOC. If the employer does
not deem the insurance cost to be unreasonable but the parent believes the cost is excessive, the
parent may write the FOC to object/request a review. The written request must include the date,
the case/docket number, be clearly labeled "Insurance Review Request", include the basis for the
objection and the signature of the objecting parent.
If the court order does not specifically designate whose insurance is primary, the insurance carriers will determine this.