Medical Support and Healthcare
The FOC office is mandated to enforce court orders regarding healthcare issues in the following two ways:
- Obtaining health insurance information as required by the court order, and
- Processing and collecting uninsured expenses exceeding the annual ordinary medical amount for the year.
Exchange Information
Parents should communicate and cooperate with one another regarding their children's healthcare needs and expenses. Unless otherwise ordered in your case, each parent must provide the other parent with:
- A current insurance card (copy of card must be sent to the FOC)
- Copies of insurance information and forms necessary to submit claims.
- Copies of all insurance company Explanation of Benefits (EOB)
Reimbursement of Uninsured Extraordinary Medical Expenses
The Friend of the Court can assist with reimbursement of uninsured extraordinary medical expenses if (1) it is ordered in your uniform child support order (UCSO), and (2) if you follow the procedure set out by statute. Remember, that if you and the other parent share joint legal custody, all non-emergency healthcare treatment should be discussed and agreed upon. If you incur medical expenses without consulting the other parent, the Friend of the Court may not be able to assist you with reimbursement.
Payee Expenses: Uninsured medical expenses paid by the Payee (recipient of support) may or may not qualify as extraordinary expenses as follows:
- If Ordinary Medical Expense (OME) is not ordered, or is set to zero, in your court order, all uninsured medical expenses paid by the Payee are considered extraordinary.
- If OME is charged in your court order, then only those uninsured medical expenses that exceed the annual ordinary medical amount for the year are considered extraordinary medical expenses. OME is charged monthly and is meant to be used toward uninsured medical expenses. The recipient of support must meet the yearly OME amount before he/she can request reimbursement of uninsured medical expenses from the payer of support. Proof (receipts) must be provided to show the OME was met.
- As stated above, only extraordinary medical expenses can be reimbursed. If you are the recipient of support and OME is ordered, you must provide the other party with proof of having met the annual ordinary medical amount for the year (look at page 2 of your UCSO). Proof (receipts) are required.
- Request payment from the other party within 28 days of the final insurance payment or the date coverage was denied by using the Request for Health-Care Expense Payment form (FOC 13).
- Page 2 of the form requires you to fill in the “Obligor's %”. This amount is found on page 2 of your UCSO (the other party's % of uninsured healthcare expenses). Do the math and fill in the dollar amount the other party owes. Sign and date the form and mail or hand deliver the packet to the other party. Keep a copy for yourself.
- Provide legible copies of all bills and all EOBs to the other party with the completed form. Legible copies include the following: date of service; patient’s name; type of service; and cost of service.
- Wait 28 days for the other party to respond. You and the other party can make an agreement, the other party can pay you directly, or the other party can make payment directly to the provider.
- If you and the other party have not reached an agreement, or there has been no reimbursement from the other party, you may ask the FOC for enforcement after 28 days by completing the “complaint” portion of the Complaint for Enforcement of Health-Care Expenses form (FOC13a).
- This complaint must be submitted to the FOC within the following timelines: six months after the date of the insurer’s final denial of coverage for the expense, one year after the date the expense was incurred, and six months after the obligor’s default of an agreement to repay (copy of agreement attached).
- Submit this form along with a copy of the complete packet that was sent to the other party in Step One (including your attachments).
FOC Enforcement:
If you have followed the procedure set out above, the FOC will process your complaint by sending it to the other party. If the other party files a timely written objection, the matter will be scheduled for an FOC hearing. If the other party does not object, the amount will be enforced by the FOC office. Direct payment after the FOC has initiated enforcement requires proof of payment (receipt from the other party, copy of canceled check, or statement from health-care provider).
Additional Information:
The term HEALTHCARE is very broad and the definition is covered in the Michigan Child Support Manual. You may want to review the definition. Expenses for OVER-THE-COUNTER MEDICATION and HEALTH INSURANCE PREMIUMS are not included in the “HEALTHCARE” definition and cannot be enforced unless specifically ordered.
Each parent is obligated to comply with the Court Order regarding legal custody and uninsured medical enforcement. The Friend of the Court recognizes orthodontia as a valid healthcare expense. However, the other party should be contacted first and made aware of the choice for orthodontia, the total cost, what the insurance will cover, what the payment plan will involve, and any other pertinent information regarding the orthodontic bill. We cannot process any orthodontic bill that is past one year from the date of the beginning of the contract (the date the braces are placed on the minor child).
You must submit a detailed contract between you and the orthodontist’s office. You must sign this contract and it must show that you have committed to the payment plan. A contract is not the same as an estimate, which is just showing an interest in orthodontia, rather it commits oneself to the plan. The contract must show what the entire procedure, from start to finish including initial fees and monthly fees, will cost. The contract must also show what portion the insurance company will cover. If there is no insurance involved make sure that the orthodontist includes that information on the contract. The orthodontist’s office should be made aware that the FOC may contact their billing department to verify all information given.
Medical Enforcement Frequently Asked Questions
Q. We have an agreement that is different than our order. What should we do?
A. Even though the FOC encourages agreement and cooperation, it is important to change your order to reflect what you are doing. Therefore, contact the FOC office for assistance in the preparation of a stipulated order.
A. You have 28 days to work out arrangements with the other party before the claim can be submitted through the FOC. However, once submitted and processed through the FOC, you must pay through the FOC.
Q. What if I receive the claim from the other party and I have already paid the provider my share?
A. You should immediately contact the other party because he or she may not be aware that you have already made the payment. If you still get a request for reimbursement form from the FOC office for this service, contact the office immediately and submit proof that you have paid your share to the service provider.