Friend of the Court: Healthcare

General Information

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.

 

Where to Start

Look at your court order. For the FOC office to assist you, your order must have a provision about health care coverage and expenses. Most orders provide for one or both parties to furnish health care coverage on the children, if available at reasonable cost. Most orders also provide that uninsured non-routine expenses be split between the parities in some percentage. Routine expenses are usually paid by the custodial parent.

 

Procedure for Collection of Health Care Expenses (Pre 2005 Orders)

The medical enforcement clerk can assist you with collection of health care expenses for your children if:

1. Your court order provides for the other party to pay a portion of the expenses.
   
2. You must send a letter to the other party, with a copy of the bill(s) including proof of any payment, and the explanation of benefits from your insurance company(if any). This letter must be sent within 28 days after the insurer's final payment or denial of coverage. If the parties have no insurance coverage, the letter must be sent within one year after the expense was incurred. Allow the other party 28 days to respond. Keep a copy of the letter.
   
3. If no arrangements for payment are made by the other party, get a Demand for Medical Payment form (available in the forms section of this web site or at the FOC office.) Fill it out and return it to the FOC office with a copy of the bills, explanation of benefits, and a copy of your letter to the other party(#2). The Demand form must be received by the FOC office within one year after the expense was incurred or 6 months after a parent defaults in paying under a written agreement.
   
4. The FOC office will not enforce bills resulting from routine health care. The following are examples of what are considered routine health care expenses and are not enforceable through the FOC office:
    
   Annual physical check-ups.
   Immunizations.
   Annual dental check-ups, teeth cleaning, and fillings.
   Contact lenses
   Office calls
   Other expenses under $100 for an illness or occurrence.
   
5. After the Demand for Medical form is mailed by the FOC office, 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, you will be notified of a hearing before a referee.

 

Procedure for Collection of Health Care Expenses (Orders 2005 And After)

The Friend of the Court Office can assist you in collection of extraordinary health care expenses in certain circumstances:

1. Your order or Judgment must provide for the other party to pay all or a portion of the health care expenses. Those expenses exceeding the annual ordinary health care expense amount in your court order are eligible for reimbursement.
   
2. You must send a letter (or you may use a "Request for Health Care Expense Payment" form from our office) with a copy of the bill(s) including proof of any payments, and the explanation of benefits from your insurance company, to the other party. This letter must be sent within 28 days after the insurer's final payment or denial of coverage. If the parties have no insurance coverage, the letter must be sent within one year after the expense was incurred. Allow the other party 28 days to respond. Keep a copy of the letter.
   
3. If no arrangements for payment are made, request a "Demand for Medical Payment" form from the Friend of the Court Office. Fill it out and return it to the office with a copy of the bills, explanation of benefits, as well as a copy of your letter(#2). The Demand form must be received by the Friend of the Court within one year after the expense was incurred or 6 months after a parent defaults in paying under a written agreement.
4. The Friend of the Court Office will only enforce bills that are paid in full, unless for orthodontia or major hospital expenses.
5. After the Demand for Medical payment 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, you will be notified of a hearing date before a referee.

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