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Medical Expense Reimbursement Enforcement

Procedures for Enforcement of Health Care Expenses

1) Who Is Eligible?

If you, as the Requesting Party, have incurred out of pocket expenses for your minor child/children’s medical care and your court order states one or both parties are responsible for a percentage of uninsured health care expenses, you are entitled to assistance in collecting a percentage of the uninsured amount. If your original or most recent court order was entered after October 1, 2004, and it includes an “annual ordinary medical” expense, you are not eligible for enforcement, until your out of pocket expenses meet or exceed the “annual ordinary medical” expense amount established in your order.

Unless your order deviates from the Michigan Child Support Formula, which is used to establish or modify a child support amount, the “annual ordinary medical” expense for orders entered before October 1, 2008 is $289 for one child, $578 for two children, $867 for three, $1156 for four, and $1445 for five or more children.

However, for orders entered after October 1, 2008, the “annual ordinary medical” expense has increased such that $345 shall be paid for one child, $690 for two children, 1035 for three, $1380 for four, and $1725 for five or more children.

The Eaton County Friend of the Court has a form you should use to keep track of the annual Ordinary Health Care expenses you must incur before submitting claims for reimbursement from the other Party. The annual Ordinary Health Care expense that you must incure before submittng claims for reimbusrement from the other Party commences January 1st if each year and runs to December 31st of that year.

In the event that your prior order does not specify an Ordinary Health Care amount, the prior responsibility percentages shall be utilized until the new order is effective, and the Ordinary Health Care amounts shall accumulate for that year from the effective date of the order. The annual Ordinary Health Care amounts shall then accumulate from January 1st of the next year and each year thereafter.

2) Notice Requirements

The Requesting Party seeking reimbursement for the uninsured health care expenses must provide the Other Party with a copy of the medical bills, using the Friend of the Court’s official Demand for Medical Payment form (FOC 13a). If available, a statement from the insurance company indicating what portion of the bill was covered must be attached.

This information, including the completed annual Ordinary Health Care expense form, must be mailed with the demand for medical expense reimbursement or delivered to the Other Party within 28 days of the date of service, or if an insurance company is involved, within 28 days after you have received a notice from your insurance company indicating what portion of the bill was covered. This will document to the other Party 1) that the annual Ordinary Health Care expense has been met by the requesting Party and also 2) the amount of the requested heath care reimbursement being sought. Please keep the original bills and paperwork from your insurance company, as you will need them when or if you need Friend of the Court assistance in collecting the Other Party’s percentage of the uninsured portion.

3) Waiting Period

Allow the Other Party 28 days to respond to your request for payment. If no response is received, from the Other Party, mail the Annual Ordinary Health Care Expense Form and or the Demand for Medical Reimbursement Form to the Friend of the Court. Include copies of the medical bills, and a copy of the notice received from the insurance company indicating what portion of the bill was covered.

4) Requesting FOC Enforcement

The paperwork must be submitted to the Friend of the Court on or before any of the following: a. Within one (1) year after the expense(s) was/were incurred; or b. Within six months after the insurer’s final payment or denial of coverage; as long as all measures necessary to submit the claim to insurance were completed within 2 months after the expense was incurred. c. Within six (6) months after the Other Party defaults on paying the expense if the Other Party had a written agreement outlining how much each parent would pay and a schedule for the payment.

Medical enforcement questions can be answered by calling: Pat Priesman, Medical Enforcement Caseworker, (5l7) 543-6850, ext. 1837, or by emailing her at ppriesman@eatoncounty.org. To obtain the Annual Ordinary Heath Care Expense Form and Demand for Medical Expense Reimbursement Form you may download the forms from the links below.

 

Medical Expense Reimbursement Forms

 

1) If you would like to download and print the INSTRUCTIONS for the Eaton County Friend of the Court Annual Log Form and the Demand for Payment of Uninsured Health Care Expenses Form, click here: [Instructions regarding Annual Log Form and Demand for Payment of Uninsured Health Care Expenses Form]

2. If you would like to download and print the Eaton County Friend of the Court Annual Log for Uninsured Health Care Expenses Form, click here: [Eaton County Friend of the Court Annual Log for Uninsured Health Care Expenses Form]

3) If you would like to download and print the Eaton County Friend of the Court Demand for Payment of Uninsured Health Care Expenses Form, click here: [Demand for Payment of Uninsured Health Care Expenses Form]

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