Uninsured Medical Cost

[diz]

What is the name of your state? CA

A couple of questions that may test the gray area in the law.

1) Family code 4063 - "health care costs that are not paid for by insurance".
We have been told that co-pays do not fall under uninsured medical (health) care costs because...
a) it's technically a "pre-payment or cost to just get in to see the doctor
b) is part of your insurance agreement not technically a "medical cost"
c) is covered under child support payments

If it is court ordered to pay 1/2 of uninsured medical costs, do co-pays fall under the uninsured medical cost?

2) In our situation one parent has taken the child/teen to a psychiatrist. There were 8 appointments. Only 4 of those appointments the child/teen attended. 3 of those appointments the parent attended alone. 1 of those appointments was a no show. Wouldn't the other parent only be responsible for the appointments that the child attended or none because the co-pay is not an uninsured medical cost?

3) Can braces be charged as an uninsured medical/dental cost or because it's a cosmetic issue do they not fall under this catagory.

Court papers say that both parents are to carry insurance for the children and that uninsured medical costs are to be split 50/50 according to the family code 4063.

 

[LdiJ]

What is the name of your state? CA

A couple of questions that may test the gray area in the law.

1) Family code 4063 - "health care costs that are not paid for by insurance".
We have been told that co-pays do not fall under uninsured medical (health) care costs because...
a) it's technically a "pre-payment or cost to just get in to see the doctor
b) is part of your insurance agreement not technically a "medical cost"
c) is covered under child support payments

If it is court ordered to pay 1/2 of uninsured medical costs, do co-pays fall under the uninsured medical cost?

Yes, co-pays are part of uninsured/unreimbursed medical costs. If you try to use the above arguments in court you are going to get laughed at.

2) In our situation one parent has taken the child/teen to a psychiatrist. There were 8 appointments. Only 4 of those appointments the child/teen attended. 3 of those appointments the parent attended alone. 1 of those appointments was a no show. Wouldn't the other parent only be responsible for the appointments that the child attended or none because the co-pay is not an uninsured medical cost?

The co-pay is an uninsured/unreimbursed medical cost. If the sessions with the parent were still due to the children's issues...and not specifically the parent's issues, then you may still be responsible for those. If they were solely for parent...then its their cost. The missed appointment could arguably be put solely on the parent if she/he was the reason why it was missed.

3) Can braces be charged as an uninsured medical/dental cost or because it's a cosmetic issue do they not fall under this catagory.

Yes..most braces are NOT merely for cosmetic purposes.

Court papers say that both parents are to carry insurance for the children and that uninsured medical costs are to be split 50/50 according to the family code 4063.

Yep, and if you are both carrying insurance then at least one of your plans may cover part of the cost of the braces...if both do, then you may get close to all of it covered.....You ARE using one insurance as primary and the other as secondary?..Correct?

 

[abstract99]

1) Most insurance companies only charge a SMALL co-pay so I am a little confused what the big deal is anyways. Mine is only 20 dollars so even if my ex refuses to cover her half of the 10 dollars I will survive.

2) You might have to pay for the psych visits you might not have to. I have heard of parents who alienate the other parent from the children having to pay for psych visits for oth other parent.

3) Braces are usually only considered cosmetic by insurance companies not the courts. Usuall if a child has a messed up grill the courts will order the other parent to cover half of the expenses. Don't assume that just because your insurance company says that something is cosmetic that the courts will feel the same way.

You should really either pay your half or chances are that you will have a lot to answer for in court. You'll sound like a fool if you just go t court and say that you aren't paying it because someone told you that you don't have to.

 

[LdiJ]

1) Most insurance companies only charge a SMALL co-pay so I am a little confused what the big deal is anyways. Mine is only 20 dollars so even if my ex refuses to cover her half of the 10 dollars I will survive.

Because if you have multiple kids and are on a tight budget those co-pays can really add up....particularly if the kids are in daycare and/or school and catch all the latest "bugs" that get passed around. 20 bucks can be a big deal in some budgets....20 bucks times two or three plus the co-pays on prescriptions can make the difference between whether or not the electric bill gets paid....or the gas bill in the winter...etc.

2) You might have to pay for the psych visits you might not have to. I have heard of parents who alienate the other parent from the children having to pay for psych visits for oth other parent.

That sentence didn't make a whole lot of sense newguy....lol

3) Braces are usually only considered cosmetic by insurance companies not the courts. Usuall if a child has a messed up grill the courts will order the other parent to cover half of the expenses. Don't assume that just because your insurance company says that something is cosmetic that the courts will feel the same way.

Agreed...insurance companies don't like to cover braces. However if you have dental insurance usually at least some of the cost will be covered.

You should really either pay your half or chances are that you will have a lot to answer for in court. You'll sound like a fool if you just go t court and say that you aren't paying it because someone told you that you don't have to.

100% agree

 

[abstract99]

Because if you have multiple kids and are on a tight budget those co-pays can really add up....particularly if the kids are in daycare and/or school and catch all the latest "bugs" that get passed around. 20 bucks can be a big deal in some budgets....20 bucks times two or three plus the co-pays on prescriptions can make the difference between whether or not the electric bill gets paid....or the gas bill in the winter...etc.

I guess but he had the kids so if he is required to pay 1/2 of all medical then this would be included.

That sentence didn't make a whole lot of sense newguy....lol

Meaning it depends on the circumstances as to why the mom is going to couseling. I personally am requesting the next time that I go to court that mom pay 100% of therapist visits for me and kids to help repair the dammage that has now been done due to moms actions.

 

[casa]

1) Most insurance companies only charge a SMALL co-pay so I am a little confused what the big deal is anyways. Mine is only 20 dollars so even if my ex refuses to cover her half of the 10 dollars I will survive.

2) You might have to pay for the psych visits you might not have to. I have heard of parents who alienate the other parent from the children having to pay for psych visits for oth other parent.

3) Braces are usually only considered cosmetic by insurance companies not the courts. Usuall if a child has a messed up grill the courts will order the other parent to cover half of the expenses. Don't assume that just because your insurance company says that something is cosmetic that the courts will feel the same way.

You should really either pay your half or chances are that you will have a lot to answer for in court. You'll sound like a fool if you just go t court and say that you aren't paying it because someone told you that you don't have to.

Well if the parent carrying ins. opts for higher co-pays instead of higher monthly ins. costs...it really adds up! My nuttyX did this to 'get back' at me for enforcing court order that he is to provide ins. I have 2 children, co-pays $35, 2 different monthly medications $25 co-pay for those, and one is in counseling with co-pays to the tune of $140 month. That's A LOT of money when you are a single parent, believe me.

 

[haiku]

FYI you also want to check guidelines, quite a few states require the custodial to pay a certain amount of unpaid medical before the percentage kicks in. (in my state for example, the custodial pays the first 100 per kid before the 50/50 kicks in) I was completely unaware of this until co-pays became a sticking point in a battle, and we did a little research.

 

[Summerland45]

FYI you also want to check guidelines, quite a few states require the custodial to pay a certain amount of unpaid medical before the percentage kicks in. (in my state for example, the custodial pays the first 100 per kid before the 50/50 kicks in) I was completely unaware of this until co-pays became a sticking point in a battle, and we did a little research.

That is really interesting! I live in Kansas and I hadn't heard that about the unpaid medical. How do they arrive at the first $100 per kid? My husband has an ex wife that takes the boys to the doctor if they sneeze and she doesn't think it sounds right. I am not exaggerating!! In 4 months, she had run up $860 in co-pays (they're only $20) and prescriptions, had two knee surgeries for the one boy and tonsils and sinus surgery for the other one. We had asked her to please give us the bills every couple of weeks to keep things current with her and she gave them to us every 2 months, before I knew it, we owed over $800!! He already pays her $738 in c.s. each month and at least another $200 or so each month in prescriptions and dr office visits. There is like no end to the $ she runs up.

Do you think a judge would make her put a limit on how often she goes to the doctor? or even require her to call when she is buying $300 glasses from the optomistrist instead of the Wal-Mart? or $46 for contacts at the eye doctor's instead of the Wal-mart where they are 1/2 of that? We never know she is doing this until months later and she finally gets around to giving us the bill.

The kids are sick to death of going to the doctor and the oldest boy refuses to go. Then she starts in on the youngest one and he is so sickly and pale, I honestly think he is taking too much medication!!

What are your thoughts?

 

[brisgirl825]

That is really interesting! I live in Kansas and I hadn't heard that about the unpaid medical. How do they arrive at the first $100 per kid? My husband has an ex wife that takes the boys to the doctor if they sneeze and she doesn't think it sounds right. I am not exaggerating!! In 4 months, she had run up $860 in co-pays (they're only $20) and prescriptions, had two knee surgeries for the one boy and tonsils and sinus surgery for the other one. We had asked her to please give us the bills every couple of weeks to keep things current with her and she gave them to us every 2 months, before I knew it, we owed over $800!! He already pays her $738 in c.s. each month and at least another $200 or so each month in prescriptions and dr office visits. There is like no end to the $ she runs up.

Do you think a judge would make her put a limit on how often she goes to the doctor? or even require her to call when she is buying $300 glasses from the optomistrist instead of the Wal-Mart? or $46 for contacts at the eye doctor's instead of the Wal-mart where they are 1/2 of that? We never know she is doing this until months later and she finally gets around to giving us the bill.

The kids are sick to death of going to the doctor and the oldest boy refuses to go. Then she starts in on the youngest one and he is so sickly and pale, I honestly think he is taking too much medication!!

What are your thoughts?

Look at your CO. Mine is also done in Ks and it says that if I want reimbursed for uninsured costs that I have to submit them to him no later than 30 days after I am billed. I usually do wait until the end of the 30 days just bc I hate sending him certified letters for a single $15 copay. He also only has 30 to pay.
Anyway, so look at your CO, that help eliminate the problem of getting slammed with $800 bills all at once.

Sarah

 

[haiku]

That is really interesting! I live in Kansas and I hadn't heard that about the unpaid medical. How do they arrive at the first $100 per kid?

***This is a specific state guideline, you would hhave ot read kansas guiidelines t see if they do this too.****

My husband has an ex wife that takes the boys to the doctor if they sneeze and she doesn't think it sounds right. I am not exaggerating!! In 4 months, she had run up $860 in co-pays (they're only $20) and prescriptions, had two knee surgeries for the one boy and tonsils and sinus surgery for the other one. We had asked her to please give us the bills every couple of weeks to keep things current with her and she gave them to us every 2 months, before I knew it, we owed over $800!! He already pays her $738 in c.s. each month and at least another $200 or so each month in prescriptions and dr office visits. There is like no end to the $ she runs up.

Do you think a judge would make her put a limit on how often she goes to the doctor? or even require her to call when she is buying $300 glasses from the optomistrist instead of the Wal-Mart? or $46 for contacts at the eye doctor's instead of the Wal-mart where they are 1/2 of that? We never know she is doing this until months later and she finally gets around to giving us the bill.

The kids are sick to death of going to the doctor and the oldest boy refuses to go. Then she starts in on the youngest one and he is so sickly and pale, I honestly think he is taking too much medication!!

What are your thoughts?

first you should read the kansas general guidelines fo rsupport, meanwhile yo ushould be getting out your husbands court order, an dm,ake sure it is being followed to the letter.

there are some things that can really help in a court order, and if you don't have them, you may want to weigh the costs of going back to court (costs include financial and aggravation, and the possibility that while in court you may end up being hit with a higher support payment. And rocking the boat and damaging any sort of good relationship with your ex etc...)

If there is insurance, it is important that it is court ordered you stay within the insurance network, any parent going outside the network must pay the full cost of going outside the network, unless there is no choice.

next important addition is that the parent who procures the medical services must send a copy of the bill within 30 days of services rendered or again they get stuck with the full cost of the bill. this keeps the other parent from getting socked with a huge bill all at once.

it is also a good idea that each parent pay thier share directly to the doctor involved rather than reimburse each other, that way there will be no questions as to who owes what.

if you go to the kansas government pages there will likely be links to statrt you on your way, but dig out the custody papers and see what they say exactly.

 

[Inquiry123]

What is a co-pay?

Is a co-pay...a banana? Is a co-pay...a cloud floating by on a warm summer day? Is a co-pay...a Greek tragedy?

Nope.

A co-pay IS..."a health care cost not paid for by insurance". Who gets the co-pay? The insurance company? No...the doctor gets the co-pay. The doctor spends the co-pay. So, "technically" it is a medical cost.

In other words, under most insurance plans...if health care is obtained...a co-pay had to be paid as part of the health care cost...the co-pay amount for the health care cost is not paid for by insurance. It's a health care cost not paid for by insurance.

Let's say we're talking about Rx medications. Is the Prescription Plan co-pay a cost "to just get in to see" the pharmacist? Nope. The co-pay is a health care cost not paid for by insurance.

Let's say we're talking about the Mercedes. Is the deductible (co-pay) a cost "to just get in to see" the mechanic? No. It is a car repair cost not paid for by insurance. Fortunately, we do not have to pay our ex's uncovered car repair costs.

And, no, if it is detailed as a seperate expense item in your decree, uncovered health care costs are not covered by base child support.

Count your blessings...can you imagine paying your 1/2 of the health care costs of an uninsured chronically ill child.

 

[Summerland45]

Look at your CO. Mine is also done in Ks and it says that if I want reimbursed for uninsured costs that I have to submit them to him no later than 30 days after I am billed. I usually do wait until the end of the 30 days just bc I hate sending him certified letters for a single $15 copay. He also only has 30 to pay.
Anyway, so look at your CO, that help eliminate the problem of getting slammed with $800 bills all at once.

Sarah

Well it would be a blessing if she only gave us a bill for $15 at a time. She doesn't send anything certified. She hands us a stack of bills each time we exchange kids. The one boy goes to the doctor 4-5 times in a month for allergy shots that were only supposed to last 6 months, that was about 2 years ago, that's $100 a month, his medicine is around $50 a month, for 5 prescriptions, the other boy goes for acne on his face 1-2 times a month for routine and follow up!! We pay 57.4% of all of this in a month. I guess what gets me is that she has a family policy for two other kids and these boys could have been added for no extra charge and would have picked up the cost as a secondary insurance and nobody would have out of pocket expenses. The judge only told her she needed to submit the bills sooner than 2 months at a time. We have no problem paying our share, its the bills that are $200 at a time that we can't handle. Now that we know how the judgement works, I guess she can spend her time to drag back into court if she isn't going to give us the bills in a timely manner so we can handle the amount of paying for them. I don't think she should be allowed to have all the say so in where she buys glasses, contacts, etc just because she isn't paying the whole bill. She tried putting all the bills in my husbands name at the doctor's office and when he called to find out about the charges, they wouldn't give him any information because of the "hippa" laws, yet the bill was in his name. He hadn't guaranteed anything for anybody.

I on the other hand have a dead beat ex, he owes me lots of child support from the past 12 years and he has NEVER provided the health insurance for our son! I have always provided it. I know I can keep the steady job. In 12 years I have had a judgement for $255 in medical, my son is extremely healthy and I did get the judgement, but they just added it the arrearage of his some $6000+ arrearage. So when my son turns 23 that's going to be the last money he pays is on those medical bills.

I do believe that both parents are responsible for raising their children, married or divorced. But I do not believe it is right for the mother to take advantage of a good situation where the father pays faithfully child support and medical bills for 12 years and abuses the system which is exactly what my husband's ex is doing. Taking advantage. KS is a huge advocate for women, but there are some fathers who pay their obligations and get screwed over in the mean time. What she provided in court to the judge was nothing we had ever seen before. The dates on the things she had given us did not match what she had given him. Huge descrepencies. He didnt' seem to really care about that. I write on the papers, every time she hands it to us the date we have received it and she does NOT send anything certified.

Thanks for the input. Feel free to continue this post.
I find the opinions interesting.
Sumerland45

 

[HcbmIssues]

Uninsured medical costs

What exactly is considered uninsured medical costs? My stepson needed braces it was medically recommended and he was referred by a dentist to the orthodontist he has such a severe overbite that it is affecting his speech and his eating habits. He also sees a psychiatrist for ADHD he was referred by his primary physician because she cannot write the prescription for the medication he needs only a psychiatrist can do that. The biological mother is trying to claim that the psychiatrist visit and the braces are not medically necessary and not covered under uninsured medical costs. California

 

[CTU]

What exactly is considered uninsured medical costs? My stepson needed braces it was medically recommended and he was referred by a dentist to the orthodontist he has such a severe overbite that it is affecting his speech and his eating habits. He also sees a psychiatrist for ADHD he was referred by his primary physician because she cannot write the prescription for the medication he needs only a psychiatrist can do that. The biological mother is trying to claim that the psychiatrist visit and the braces are not medically necessary and not covered under uninsured medical costs. California

No no no.

1. Don't dig up old threads. This is OVER TEN YEARS OLD.
2. It's just "Mother".
3. ONCE AGAIN please have the parent sign up to discuss his/her legal problems.

Thanks.