Health Care Reimbursements
I pay for all medical expenses. How do I get reimbursed for medical expenses?
Health care reimbursements for your child’s medical expenses are addressed in California Family Code Section 4063. The California courts use this state statute to address how one parent is to obtain health care reimbursements when they make out-of-pocket payments for medical costs. Health care reimbursements, like other out-of-pocket expenses you may pay for your child, are often referred to as “additional child support costs.”
Can the court order that a parent pay medical bills? Can the court order that a parent pay doctor’s bills?
Family Code Section 4063 states:
(a) When making an order pursuant to paragraph (2) of subdivision (a) of Section 4062, the court shall:
(1) Advise each parent, in writing or on the record, of his or her rights and liabilities, including financial responsibilities.
(2) Include in its order the time period for a parent to reimburse the other parent for the reimbursing parent’s share of the reasonable additional child support costs subject to the requirements of this section.
(b) Unless there has been an assignment of rights pursuant to Section 11477 of the Welfare and Institutions Code, when either parent accrues or pays costs pursuant to an order under this section, that parent shall provide the other parent with an itemized statement of the costs within a reasonable time, but not more than 30 days after accruing the costs. These costs shall then be paid as follows:
(1) If a parent has already paid all of these costs, that parent shall provide proof of payment and a request for reimbursement of his or her court-ordered share to the other parent.
(2) If a parent has paid his or her court-ordered share of the costs only, that parent shall provide proof of payment to the other parent, request the other parent to pay the remainder of the costs directly to the provider, and provide the reimbursing parent with any necessary information about how to make the payment to the provider.
(3) The other parent shall make the reimbursement or pay the remaining costs within the time period specified by the court, or, if no period is specified, within a reasonable time not to exceed 30 days from notification of the amount due, or according to any payment schedule set by the health care provider for either parent unless the parties agree in writing to another payment schedule or the court finds good cause for setting another payment schedule.
(4) If the reimbursing parent disputes a request for payment, that parent shall pay the requested amount and thereafter may seek judicial relief under this section and Section 290. If the reimbursing parent fails to pay the other parent as required by this subdivision, the other parent may seek judicial relief under this section and Section 290.
(c) Either parent may file a noticed motion to enforce an order issued pursuant to this section. In addition to the court’s powers under Section 290, the court may award filing costs and reasonable attorney’s fees if it finds that either party acted without reasonable cause regarding his or her obligations pursuant to this section.
(d) There is a rebuttable presumption that the costs actually paid for the uninsured health care needs of the children are reasonable, except as provided in subdivision (e).
(e) Except as provided in subdivision (g):
(1) The health care insurance coverage, including, but not limited to, coverage for emergency treatment, provided by a parent pursuant to a court order, shall be the coverage to be utilized at all times, consistent with the requirements of that coverage, unless the other parent can show that the health care insurance coverage is inadequate to meet the child’s needs.
(2) If either parent obtains health care insurance coverage in addition to that provided pursuant to the court order, that parent shall bear sole financial responsibility for the costs of that additional coverage and the costs of any care or treatment obtained pursuant thereto in excess of the costs that would have been incurred under the health care insurance coverage provided for in the court order.
(f) Except as provided in subdivision (g):
(1) If the health care insurance coverage provided by a parent pursuant to a court order designates a preferred health care provider, that preferred provider shall be used at all times, consistent with the terms and requirements of that coverage.
(2) If either parent uses a health care provider other than the preferred provider inconsistent with the terms and requirements of the court-ordered health care insurance coverage, the parent obtaining that care shall bear the sole responsibility for any nonreimbursable health care costs in excess of the costs that would have been incurred under the court-ordered health care insurance coverage had the preferred provider been used.
(g) When ruling on a motion made pursuant to this section, in order to ensure that the health care needs of the child under this section are met, the court shall consider all relevant facts, including, but not limited to, the following:
(1) The geographic access and reasonable availability of necessary health care for the child which complies with the terms of the health care insurance coverage paid for by either parent pursuant to a court order. Health insurance shall be rebuttably presumed to be accessible if services to be provided are within 50 miles of the residence of the child subject to the support order. If the court determines that health insurance is not accessible, the court shall state the reason on the record.
(2) The necessity of emergency medical treatment that may have precluded the use of the health care insurance, or the preferred health care provider required under the insurance, provided by either parent pursuant to a court order.
(3) The special medical needs of the child.
(4) The reasonable inability of a parent to pay the full amount of reimbursement within a 30-day period and the resulting necessity for a court-ordered payment schedule.
Click on the following link to download a California Health Care Reimbursements Order form which is used in California courts.
File Download (PDF File): fl192 – notice of health care and reimbursement
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