Objections to reimbursement for extraordinary medical expenses can be based on the necessity of the expense, a claim that the parent has already paid the expense or to raise any similar defenses to the demand for reimbursement. The objection will be raised by the parent from whom reimbursement is being sought.
One of the objections is that the health expense was for services that were not a medical necessity. Medical necessity has been defined as health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. The question becomes who determines if the treatment is a medical necessity. Is it the treating health care provider, the insurance company, politicians or the court? The answer is it depends on when the determination is being made. For medical reimbursement objections, the final determination will be made by the court after reviewing both medical records and insurance records. A requesting parent can be prepared to meet this objection by acting while the treatment is ongoing or shortly thereafter.
The first step in defending against any future objections is to get the documentation immediately. If a health care provider has recommended treatment for the child that is not covered by insurance and will exceed the ordinary uninsured health care threshold, then a request to the health care provider to write a letter detailing why the treatment is a medical necessity is the first step in preparing for such an objection. Retaining copies of all correspondence from the insurance company will also assist in the process. If insurance is provided by other parent, ask that parent to sign whatever documents are necessary to allow copies of insurance correspondence regarding the minor child to be forwarded to non-insuring parent. These steps can be strategic in overcoming objections to reimbursement requests.
For instance, in a matter for extraordinary health care reimbursement handled by this firm, the father contested paying his pro rata share of residential psychological treatment for his child and cited that it was not a medical necessity. The child was being treated for suicidal ideation and depression. The child had been hospitalized for an extended period and spent much of the time at the residential treatment facility on “suicide watch.” When the insurance refused to cover further time at the facility, the custodial parent continued the treatment given that the child had not been taken off suicide watch. The custodial parent had to obtain copies of the treating psychiatrist’s notes, treating therapist’s notes, and staff notes from the facility. Given the age of the child and the mental health code in the state where treatment occurred, the consent of the child to release the records was required. After reviewing the notations about the child’s state of mind and persistent threats to commit suicide, the Friend of the Court Referee determined that the continuation of the treatment for the child was a medical necessity. The father’s objection was based solely on the denial of coverage from the insurance provider. The father did not appeal the Referee’s recommendation to the court.
In another matter for extraordinary health care reimbursement, the paying parent objected to the reimbursement of uninsured expenses for dental treatment. In this matter, the child had chipped a tooth. To properly repair the damaged tooth, a space between the tooth and adjacent tooth had to be repaired. The objection raised by the paying parent was that the additional repair was not a medical necessity. After the requesting parent provided a letter from the treating dentist regarding the treatment and review of the records by a dentist of the paying parent’s choice, the court determined that the treatment was a medical necessity.
As for the other objections that can be raised against reimbursement, detailed record-keeping and accounting should resolve any objection. If parents share joint legal custody, each parent should notify and give the other parent an opportunity to be present for all routine medical, dental, optical and psychological treatment. Furthermore, joint legal custody means that the parents should consult together and attempt to agree before major decisions are made affecting the child’s health. When parents work together on treatment decisions for their child, the agreement should also encompass how the treatment will be paid or reimbursed.
If you are struggling on determining medical necessity with your ex, contact us today! We can help you navigate medical reimbursements with peace of mind.