What are medically necessary medical exspenses?

[chatkat]

What is the name of your state? Texas
My daughter is 15 and has Mild Cerebral Palsy. She is very eagar to drive but may need modifications to a vehicle. Her doctor recommended she be taken to a Rehabilitation Service that evaluates people with diabilities to determine what modifications she may need. The facility does require a perscription from the doctor and a perscription would also be required for any modifications made to the vehicle. I spoke to my insurance company and because the place is a rehabilitation facility it can be claimed on the insurance, but it will be placed under out of network providers where the deductable is much higher and therefore none of the expense will be covered by the insurance. My question is will the evaluation, possible special driving school and vehicle modifications fall under medically necessary expenses which my ex husband and I have to share 50-50? If there are any sites I can go to to read up on the law of what is considered medically necessary please let me know.

Thank you
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[stealth2]

That's an excellent question! I don't personally know the answer, but will see if I can turn anything up for you over the next couple of days.

 

[nextwife]

I'm not certain. but my guess would be that DRIVING is considered a privilage, but not considered medically necessary.

 

[stealth2]

However, I could see a good attorney making an argument that it would provide a level of independence for the young lady that would (a) allow Mom to work and (b) provide for self-sufficiency when the parents both die - and therefore more of a necessity than not.

Just thinking "aloud".

 

[chatkat]

I can also see both sides of the situation and that is why I'm curious as to what the law has to say about it. Thank you for the responses so far and for any additional information.

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[chatkat]

Found an answer

Stealth,
I wanted to let you know that I finally heard back from my Attorney today. He said that evaluations, training and modifications for the purpose of driving are not considered a medical expense. He said that it is possible that both sides of the situation could be fought in court, but he doens't believe the a court would rule driving as a medical need.

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[LdiJ]

Stealth,
I wanted to let you know that I finally heard back from my Attorney today. He said that evaluations, training and modifications for the purpose of driving are not considered a medical expense. He said that it is possible that both sides of the situation could be fought in court, but he doens't believe the a court would rule driving as a medical need.

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I disagree with your attorney. I am not saying that a judge would absolutely rule in your favor, but Stealth made some really good arguments regarding the eventual independence of the child and her eventual ability to meet her own needs should mom and dad no longer be available.

My brother in law is technically a quadraplegic although he does have the use of his arms. (its a medical distinction based on where his paralysis starts). He was in the army when the accident happened. Part of his rehabilitation was that he was not permitted to leave the rehab facility until he had mastered all aspects of independent living, including learning to drive a car with hand controls. That alone was probably the most important part of his rehab in the end. He was only 21 when it happened and he was a fully functioning, able to support himself adult at 22....and DID.

I recommend fighting for your daughter to the bitter end on this one.....it can open up the world to her.

EDIT: And shame, shame, shame to the other parent if they don't embrace this fully.

 

[chatkat]

Shame Shame to me then

I will accept that.
I have had custody of my daughter for 14 1/2 years. I was out of work and on welfare for 2 years after she was diagnosed with Cerebral Palsy at age 1. I went back to work when she was 3 years old and started school and her therapy was provided through the district. My daughter has had multiple surgeries which have required me to take unpaid leave from work for up to 3 months at at time. The doctors said they didn't know if she would ever walk when she was diagnosed, I made sure she learned to sit up and walk and stand alone and every other ability she has. My blood, sweat, heart and soul are in every thing she is able to do. Not only can she walk now, most people can't even notice the diability until they get to know her. I take the credit for all of that. Her father never attended threapy, or doctors appointments. He never once volunteered to take time off with her and take a lose in pay, he never paid any extra for all the travel or had anything to do with her progress. In fact he does just the opposite. He and his wife told her that she looked silly in her leg braces so when she was/is with them she doesn't wear them. I have been talking to my ex about my daughter needing special driving training and modifications for 3 years and he and his wife had told me they couldn't afford to help pay. I told my daughter I couldn't afford it either and we would probably have to wait until she was 18 to apply for assitance from the Texas Rehabilitation Com. My daughter complained to her dad that she didn't want to wait that long. 3 of the 4 children in his home got their license and a car for their 16th birthday and she didn't want to wait. So when all this started less then a year ago, her dad told her that she didn't need any special modifications and that he could parent teach her and she wouldn't even have to take a driving test with a DPS officer. My daughter was so excited that she moved in with him and keeps telling me when she is going to get her permit.
Well SM took her to her last Specialist appointment after her dad told me he was taking her and didn't want me there. Well the doctor said my daughters gait has gotten worse and they are going to have to start more intense treatment to reverse the damage. Why? because she doesn't wear her braces at her dads nor does she stretch like she is supposed to. Second, they couldn't do the treatment because SM can't sign for treatment, so because dad didn't go, my daughters treatment is being delayed. Third, SM said that dad was going to parent teach her to drive and the doctor put a stop to that real quick. He gave her a perscription for the evaluation and told her that he was going to document the conversation so that if they failed to act responsibly and lied to the state or the ins co, he would have it on record that they were told. So, now they hear from the doc what I have been telling them for 3 years. I couldn't afford it when I had custody what makes anyone think I can afford it when I now have less income then I had before.??? They knew and they purposely mislead my daughter to make me look bad. If they want her to have her license and a car by the time she is 16 then that is their choice. There are 5 other licensed drivers in that house, it is not medically necessary that my daughter get her license by 16. If they want help paying for it, then they can wait until she is 18 and request assistance from the TRC just like I was going to do.

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