What Is Included in Unreimbursed Medical Expenses for a Divorce?

by Beverly Bird
Unreimbursed medical expenses are anything your insurance doesn't cover.

Unreimbursed medical expenses are anything your insurance doesn't cover.

Jupiterimages/Goodshoot/Getty Images

In the context of divorce, issues of medical expenses often arise with regard to the children. Kids get sick and require care. With or without health insurance, these expenses can get out of hand. Most courts agree that the custodial parent should not be solely responsible for paying them, and they distribute these costs between parents. Some states include them in child support. However, in most jurisdictions, the non-custodial parent must contribute to them separately.

Divorce is never easy, but we can help. Learn More

Definition

If your child is not covered by a health insurance policy, all his medical expenses are unreimbursed because there’s no insurance provider to pick up part of the tab. On the other hand, unreimbursed medical expenses can also be those expenses the insurance policy does not cover. Some states refer to these as uninsured medical expenses or extraordinary medical expenses. These also include co-pays parents must pay when a child goes to the pediatrician or needs a prescription filled. If your policy has a deductible that you must pay yourself before the insurance kicks in, this is also considered an unreimbursed medical expense.

What’s Included

Most states differentiate between necessary and unnecessary medical expenses. If your child breaks his arm and you must take him to the emergency room, this and follow-up trips to his doctor are obviously necessary. Wellness check-ups are included, as well as all visits to a pediatrician or dentist when your child becomes sick or develops a problem. Cosmetic issues are rarely covered unless they present a health risk. Counseling, psychiatric and psychological treatments sometimes fall into a gray area. In many states, you must get court approval for such care if you expect your ex to contribute to the costs. Most courts take a dim view of chiropractic expenses because judges usually see this sort of treatment as elective rather than medically necessary. If your divorce decree doesn’t specify approved expenses, confer with an attorney before you incur any uncertain costs, if possible. An attorney will know what the courts in your jurisdiction are likely to enforce if your ex doesn’t contribute payment on his own.

Payment

The laws and norms in each state determine how much each parent pays toward unreimbursed medical expenses. If your child requires chronic care, some states, such as New York, will build the costs into your child support order as “add-ons.” Otherwise, it is difficult to anticipate what your yearly unreimbursed expenses might be. Therefore, divorce decrees usually make separate provisions for their payment. In most states, the custodial parent is responsible for an initial dollar amount. For example, custodial parents in New Jersey are responsible for paying the first $250 in unreimbursed medical costs per year per child. Courts then divide anything incurred over and above this amount between the parents in a variety of ways. Some states might order the non-custodial parent to pay the entire balance over the initial dollar amount. Many jurisdictions divide the balance according to parents’ incomes. For example, if you earn $30,000 a year and your ex earns $60,000, you might be required to pay one-third of the balance and he might have to pay two-thirds of it.

Disputes Between Parents

The custodial parent is usually responsible for paying health-care providers directly, out of her own pocket. She must then “bill” her ex for his share and he reimburses her. This system may not work well if your ex frequently disagrees with you over the necessity for treatment, or if he habitually doesn’t get around to reimbursing you. As long as your decree contains some reference to unreimbursed medical expenses, you can usually take him back to court to demand payment. In cases where the treatment was clearly necessary, the court will order him to pay up or may even revise your order so he’s responsible for paying his share directly to health care providers going forward. Otherwise, you may have to prove the necessity of the treatment for which you paid.