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Learn what uninsured medical expenses are for child support purposes and how these expenses are split.

By WomansDivorce | Answers by Brette Sember, J.D.

Many divorced parents find it challenging to pay for all the costs associated with raising a child. Child support can help cover some of the basic necessities for a child, such as food, clothing and housing. But what happens if you have medical expenses for your child? A child support order can also address how the parents will pay for uncovered medical expenses and who will carry health insurance on the child.

What are Uninsured Medical Expenses?

Uninsured medical expenses generally include all medical expenses not paid for by health insurance. These expenses can include:

  • Co-pays for health care appointments
  • Prescription drug costs
  • Health insurance deductibles
  • Out-of-network costs
  • Physical therapy
  • Adaptive devices such as braces or wheelchairs
  • Uninsured dental or vision expenses
  • Mental health treatment, such as counseling or therapy

Other things that could be taken into consideration are speech therapy and other elective medical expenses such as dental braces. Cosmetic surgery generally wouldn’t qualify as an uninsured medical expense unless it was a medically necessary treatment for the child.

How are Uncovered Medical Expenses Split?

Child support guidelines vary in how uncovered health care costs are allocated between the parents. Some states require parents to split the cost of these expenses based on a portion of their income. For example, Parent A earns $60,000 annually and Parent B earns $40,000. In this scenario, Parent A would pay for 60% of the uncovered medical expenses, while parent B would pay 40%.

In some states, uninsured medical expenses are split 50/50 between the parents, with the custodial parent paying the full bill and requesting reimbursement from the other parent for half of the bill.

And still other states require the custodial parent to pay for the uncovered medical expenses up to a certain amount per calendar year per child, after which point the expenses are split between the parents.

It is important to check the child support guidelines in your state (1) to understand how uninsured medical expenses may be handled in your specific case. You want to make sure your child support order addresses the amount or percentage of uncovered medical expenses each parent will be responsible for.

Who Pays the Initial Bill?

Usually, the custodial parent pays for the uncovered medical expense up front and then asks the other parent for reimbursement. This should be done in a timely manner to allow the other parent enough time to pay their share.

It’s a good idea to specify the time period for notifying the other parent about uninsured medical expenses in your child support order. The order also needs to address how long the parent has to reimburse their portion of the expenses. Some states have statutes limiting the time-frame for notifying the other parent about these out-of-pocket expenses. If you wait too long, you may not get reimbursed.

Divorced parents need to keep good records of their child’s medical expenses, including medical bills, receipts, and insurance claim statements. Doing so will allow you to provide documentation for reimbursement of the uncovered medical expenses. It’s a good idea to make copies of these documents if the other parent requests a physical copy.

Questions about Uninsured Medical Expenses

Not outlining how uncovered medical expenses will be paid for in your child support order can lead to a lot of headaches down the road. Just imagine getting hit with an unexpected medical bill and the other parent refusing to help pay for it. Below you can find out how to handle these sorts of situations, as well as how long you should wait for repayment, who is responsible for medical expenses, and more.

What exactly are uncovered medical expenses?

Kinder’s Question: Earlier this week, we had to go to mediation because my ex was trying to lower his child support. Our son will be covered on health insurance through my new husband’s company and I asked about my ex paying half of the monthly premium. The mediator said that my ex is not responsible for those, but is only responsible for half of the ‘uncover medical expenses’. What exactly are uncovered medical expenses then?

Brette’s Answer: This would include co-pays and deductibles and things the insurance does not cover (dental, vision, etc.).

What does “extraordinary medical expenses” include?

Holly’s Question: My ex and I are fighting over medical costs. Our decree states “extraordinary medical expenses not covered by insurance”. When our daughter got lice at school I spent almost $100 treating her. Shouldn’t he pay his portion on over the counter for things like this? The decree is so vague.

Brette’s Answer: The problem is how your court interprets that clause. Does it mean deductibles and co-pays or things like experimental treatments — things that get pushed through traditional medical insurance? It’s unlikely to mean non-prescription meds, but you can certainly make the argument that this is an extraordinary situation (and personally I would agree with you, but I’m not sure how your court is going to interpret this clause). Good luck.

Who is responsible for uninsured medical expenses?

Carmela’s Question: My ex-husband is responsible for carrying medical insurance on our three kids. He is now saying that I need to pay for 1/2 the bills when they go to the doctors. Is that right if it’s not stated on our decree?

Brette’s Answer: If your decree does not specify that he is to pay them, or they are to be split, they are considered the responsibility of the primary parent, unless your state law says otherwise. You can ask to have your order modified to share these costs.

Is he also responsible for half the deductible?

Natasha’s Question: My husband was ordered to pay for half of the children’s insurance and there is a very high deductible. Does he also have to pay for the deductible too? Or is it just for half of the insurance and medicine that the kids may need?

Brette’s Answer: You should check with your lawyer. Usually the order specifies if he is to pay part of the uncovered expenses.

Is he responsible for out of pocket expenses if I carry the insurance?

Whitney’s Question: We have joint custody with no child support on either side, which was agreed on 7 years ago. We are supposed to split extra-curricular activities and medical. I have had insurance on them through my job for the last 4 years. We are supposed to split the expenses and since I have the insurance on them, isn’t he supposed to pay any out of pocket expenses?

Brette’s Answer: If your order says you are to share out of pocket costs for medical, dental and extra-curricular then he would be responsible for half. You should start by calling your attorney. Often these kinds of things can be resolved with some phone calls between attorneys. If not, you can go to court for violation and enforcement of the order.

How do I prove what he owes me for the medical bills?

Imogen’s Question: My ex-husband is ordered to pay half of all medical bills for our child. I send him the bills and receipts and over the course of a couple of months he sends in small, various amounts of money via a money order. He owes me a substantial amount of money, but how do I prove what he owes me?

Brette’s Answer: You total the bills you sent him for a three month period. You total the cash he sent. Subtract. This shows what he owes. Do it every three months.

Who is required to cover medical expenses if there is no court order?

Shelly’s Question: After living with me for the last 13 years, my son has decided to live with his dad. The original child support order required my ex to carry insurance and share 50% of the uninsured medical expenses. Since the child support order is no longer valid, my ex wants me to pay to have him put on his policy? Who is required to cover medical expenses if there is no court order?

Brette’s Answer: You’re not required to do anything unless ordered to by the court. My guess is though that if you go to court, you’ll be ordered to pay support and provide insurance.

Does the child support payment cover medical expenses?

Carrie Asks: Our divorce papers state my ex is to pay the medical coverage and half of daycare after divorce. These figures were taken into consideration when child support was being figured up. The judge ordered him to pay 500 a month in child support. Is this in addition to his continuing to pay medical coverage and daycare or is it supposed to cover those?

Brette’s Answer: It depends on what the order says. If he is directed to continue to pay medical and daycare expenses then that would be in addition to the flat amount.

Are extraordinary medical expenses separate from child support?

Annette’s Question: Along the lines of extraordinary medical expenses not covered by insurance, does this include deductibles, dental bills etc.? I have a court order that states he pays half of all medical and dental expenses and if he fails to pay, he may be forced to pay all of them. My ex is stating his lawyer advised him these expenses are “included” in his child support payment. Is this true or are the extraordinary medical and dental expenses a separate expense/payment?

Brette’s Answer: If the order says he pays half of all medical/dental then that’s exactly what that means. It is separate from child support payments.

Do I have to notify him of medical expenses within 30 days?

Angie’s Question: My decree stipulates that my ex is responsible for 1/2 our daughter’s medical co-pays, prescriptions, and deductibles. He is saying there is a 30/30 rule and if I do not notify him within 30 days of the doctor’s visit, he no longer has to pay. I live in Nevada, as does he. Is this true?

Brette’s Answer: I don’t know if your state has a specific rule about this – you should contact a local attorney. I would say 30 days would be a reasonable amount of time to notify someone of this though. (Editor’s note: Nevada does have a mechanism for requesting and obtaining reimbursement for medical expenses. Find out more about the 30/30 rule for sharing medical expenses in NV.)

How long should I wait for him to pay the extra medical expenses?

Georgiana’s Question: I am to pay all the children’s medical bills throughout the year. At the beginning of the next year I give my ex a bill and he is to pay 70% with the exception of the first $250.00. How long after I give him the bill does he have to pay this? The amount he owes me is $5000.00 and it’s been three months.

Brette’s Answer: If the order doesn’t specify, I would assume a “reasonable” amount of time would be the standard. Since it’s late March and you’re asking this question, I’m assuming he hasn’t paid you for last year. I do think 3 months is a reasonable period of time, so you could file a petition or motion with the court for enforcement/violation to get your money.

Is he liable for 1/2 the medical expenses for our teenage pregnant daughter?

Regina’s Question: If a minor child becomes pregnant when living with the custodial mother, is the non-custodial father liable for 1/2 of the medical expenses on the minor child relating to the pregnancy?

Brette’s Answer: Yes, if he is court ordered to pay the medical expenses.

Does he have to pay for half her braces?

Kristy’s Question: My husband’s child support states the he is to pay half of what insurance doesn’t pay. However, if it is for braces, don’t you have to come to a mutual agreement to set up payment plans with the orthodontist? And what happens if she already made the agreement without discussing it with him, and he doesn’t have the ability to pay it?

Brette’s Answer: If the child support order says he has to pay half, then he has to pay half of the uncovered amount of the braces. He owes the money to his ex-wife, not the orthodontist. If she sets up a payment plan, I would imagine a court would say he has to pay her the amount due each month. If it’s simpler, he can certainly pay the orthodontist directly. If he wants to be the one to negotiate the payment schedule with the orthodontist, then he’s going to have to be the one who signs it and is responsible to the orthodontist.

Can he deduct orthodontic payments from the child support?

Linda’s Question: My ex is threatening to deduct orthodontic treatment payments from the last 4 months he has to pay child support. He has never given me a bill showing the cost of these treatments which have been going on for the last 1 1/2 years. Can he do that?

Brette’s Answer: If you are saying he wants to pay orthodontic bills directly instead of paying your child support, no he has no legal right to do that unless your order permits it. Child support must be paid directly to the other parent. If he is ordered to pay medical costs in addition, those can be paid directly to the provider.

Do I have to pay half the doctor bills if I share custody?

Brandi’s Question: I am a grandparent with joint custody of my 2 grandchildren. The parents say I have to pay 1/2 of the doctor bills, is that true? It doesn’t say anything in the court order.

Brette’s Answer: That would be part of a child support order, not a custody order. If you have one, read it to see what it says.

Can he deduct health insurance premiums from the child support?

Jennifer’s Question: He gets mad every time he has to pay child support because it’s less money for him. He thinks he can deduct the amount he pays in insurance from the child support if he gets coverage for her. Can he? Also, when she’s with him I like to go out sometimes. The judge stated if we decided to go out, to just make sure we had a babysitter. Will this be enough for him to take her from me? He was unemployed a couple weeks ago and acts like he wants to see her more. Wouldn’t the judge be able to see what he is trying to do to avoid having to pay support?

Brette: If he obtains insurance for your child it does not reduce the amount of child support. If you go out when she is with him and do nothing illegal or dangerous, it shouldn’t impact custody. Unemployment would affect his child support payments since his income has changed.

Shouldn’t he pay more support if my health insurance premiums increase?

Leslie’s Question: Because I carried the health care for our family when we divorced, our divorce agreement lists me to carry the insurance. Since then I have changed jobs and the insurance for my daughter went for $170 per month to $690 per month and my ex refuses to help pay anything towards the cost. He says insurance was calculated into his child support payment. Is there anything I can do?

Brette’s Answer: You can file for modification of the order. An attorney can help you or you can use forms on the family court website.


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