The Pennsylvania Support Guidelines contain provisions with regard to payment of unreimbursed medical expenses when parties have a support order through their local domestic relations office. The procedure for reimbursement of unreimbursed medical expenses by the party not receiving support can vary from county to county in Pennsylvania and for many, the process can be confusing.
In Lancaster County, all support orders contain a provision that the individual receiving support is responsible for the first $250 of any out-of-pocket medical expenses before the individual paying support has any obligation to contribute to unreimbursed medical expenses. This $250 amount is often referred to as “the cash medical deductible.” If you are receiving support and you have incurred an out-of-pocket medical expense, what should you do? First, have you paid $250 out-of-pocket? All expenses must be submitted to the insurance provider and only what is not covered by the insurance provider is considered out-of-pocket. You must pay $250 in a calendar year to meet the threshold. Then you are able to request reimbursement of the amounts that exceed $250.
Requests for reimbursement are best made on a quarterly, biannual or annual basis. Submitting requests every time a bill is received can create an unnecessary hassle. Typically, I advise clients to keep track of all of the unreimbursed medical expenses that exceed the $250 deductible and request reimbursement from the other party on a schedule that works for your financial circumstances. The request must be made in writing with proof that you have paid $250 out-of-pocket, include the amount that has been incurred and paid above the $250 amount and then include the calculation of what the other party owes according to the terms of your support order. For example, your support order would say Payor (the person paying the support) is responsible for 53% of all unreimbursed medical expenses and Payee (the person receiving the support) is responsible for 47% of all unreimbursed medical expenses. Those percentages are then applied to the unreimbursed medical expenses above $250 to determine the amount which should be reimbursed to you. Continue Reading Support Guidelines and Unreimbursed Medical Expenses