The medical enforcement clerk in our office is available to assist you and answer your questions concerning the health care provisions in your court order. The clerk's job is to enforce the health care portion of the order. The clerk can help you obtain information about the health care coverage available to the other party to your case. The clerk can help you obtain reimbursement for health care expenses for the minor children. Finally, the clerk can calculate the "reasonable" cost of health care coverage in your case.
Procedure for Collection of Health Care Expenses
The Friend of the Court will assist in collection of health care expenses in certain circumstances:
- Your support order must provide for the other party to pay a portion of the health care expense. For orders since 2005, those expenses exceeding the annual ordinary health care expense amount in your order are eligible for reimbursement. For orders before 2005, only non-routine expenses are enforceable. (Ask the office for a copy of “Routine health care expenses.”)
- You must send a Request for Health Care Expense Payment form with a copy of the bills, including proof of any payments and the explanation of benefits from your insurance company to the other party. For orthodontia, you must also send a copy of the signed contract, proof of the down payment, and proof of the total insurance coverage. This form must be sent within 28 days after the insurer’s final payment or denial of coverage. If the parties have no insurance, the letter must be sent within one year after the expense was incurred. Allow the other party 28 days to respond and keep a copy of everything sent.
- If after 28 days no arrangements for payment are made, request a Complaint and Notice for Health Care Expense Payment form from the Friend of the Court office. Fill it out and return it to the office with a copy of the bills, an explanation of benefits, and the Request form from #2. The Complaint form must be received by the Friend of the Court within one year after the expense was incurred or six months after the insurer’s final denial of coverage for the expense.
- The Friend of the Court only takes enforcement action twice per year, in June and December. Bills must be paid in full, though exceptions are made for orthodontia and major hospital expenses.
- After the Complaint form is mailed by the Friend of the Court, the payer has 21 days to file a written objection. If no objection is filed, the amount becomes a support arrearage subject to enforcement. If an objection is filed, the matter will be set for a referee hearing and both parties must attend.