Getting Paid Back For Out Of Pocket Medical Costs Or “Unreimbursed” Medical Expenses

Do you have co-pays for doctor’s visits?  Do you have out of pocket costs for medical appointments or prescription medications? If you have a Support Order for you or your children then most likely you may be entitled to reimbursement for these expenses from the other party of the Support Order.

Most Support Orders will indicate each parties’ percentage obligation for unreimbursed medical expenses.  Support Orders are typically determined using a calculation that takes into consideration the monthly net income of both parties and then determines each parties’ percentage of the combined net monthly income.  For example, if Father’s monthly net income is $1000 and Mother’s monthly net income is $500, the total combined monthly net income is $1500.  Father’s percentage of this total is 66.66% (or 67% if rounded up) and Mother’s percentage of the total is 33%.  For support purposes this means that Father would be responsible for 67% of the unreimbursed medical expenses and Mother would be responsible for 33%.

Let’s focus on child support for this example.  If you are the custodial parent and the parent with less income, then you will be the recipient of Child Support.  The Child Support calculations automatically considers that the Support recipient is responsible for the first $250 per person and per calendar year in unreimbursed medical expenses, unless the Order states otherwise.  The default is that the recipient of support is responsible for the first $250 per person per calendar year.  After that threshold is satisfied, then the recipient could see reimbursement from the other parent for the outlay of funds for unreimbursed medical expenses.  The non-custodial parent, or the parent paying Child Support, is also entitled to seek reimbursement of unreimbursed medical expenses from the other parent, but there is not a $250 threshold that needs to be satisfied first.

The reimbursement of the unreimbursed medical expenses should be requested of the other parent with a copy of all supporting document (i.e. bills/invoices and proof of payment).  If the other parent does not reimburse the paying parent for his/her proportionate share, then the parent can seek enforcement of the Support Order through the Domestic Relations Office.  Your local Domestic Relations Office has a form for seeking Reimbursement of Unreimbursed Medical Expenses. 

Request for reimbursement must be made by no later than March 31st of the year following the medical expense or the party risks the Court not ordering the reimbursement due to the stale request. 

Generally, “medical expenses do not include cosmetic, chiropractic, psychiatric, psychological or other services unless specifically directed in the order of court, “ however “the court may apportion such expenses that it determines to be reasonable and appropriate under the circumstances.”  PA Rule of Civil Procedure: Rule 1910.16-6.

If have a question or seek assistance in getting paid for unreimbursed medical expenses or need to make a challenge to payment of unreimbursed medical expenses if they are not reasonable or necessary, please contact Dawn Padanyi, Esquire, at 267-217-3296.