Unreimbursed Medical-Orthodontic

[difficult3]

What is the name of your state? PA

My husband's ex wife already has a long history with domestic relations of causing problems with medical bills. Her paperwork is terrible, she double and triple bills, doesn't use the insurance properly. They have flagged their file to investigate any further claims she makes.

She has now hit us with orthodontic bills. Would my husband be in his right to request documentation that the procedures were medically necessary and not cosmetic? And if they were for cosmetic, would we still be forced to pay our percentage?

 

[2boys]

wow, this isn't going to be a legal answer, but I'm sorry I'm a cp and my son had an orthodontic procedure that is "cosmetic" and yes, I will make sure that the ncp pays his half.
would that child have been able to get that procedure had me and ncp been living under the same roof? yes, so why should it matter now? personally I find that to be very insensitive not only on the cp but on the child as well.
my son was thrilled to get his teeth worked on because he kept talking about people with funny teeth and how they get laughed at.

had this been plastic surgery then I'd understand. And I understand wanting documentation as to the amount but the other stuff.....

sorry, but it just smacks of being insensitive.

 

[difficult3]

I have not posted on here for awhile and forgot that I have to add my usual disclaimer that this is not about getting out of my husband's obligation. This is about the simple fact that we can not afford braces for these children. So, if they WERE still living under the same roof, the braces would not be an option at this time.

My husband has never missed a child support payment and has even continued to pay through two unemployments without requesting that his support be lowered. His ex has basically held his children hostage in Missouri and racked up thousands of dollars in legal fees for us trying to keep this kids from him for no other reason but her selfish behavior. She is married to a millionaire, does not work because of this so the kids would not go without. She has consistenly tried to milk him for unecessary medical bills, claiming he owed over $1000 one time when it was only $124. If we are hit with a $5000 bill for braces that is merely cosmetic that will mean my husband will not be able to see his children for six months or more because there will be no money for airfare and hotel to Missouri, which he has to pay 100%. You tell me how that is insensitive to her when she is on millionaire status thanks to her husband?

Please do not judge my situation without all of the facts. Although I was now reminded that I needed to give the whole story.

 

[weenor]

No body can really give good advice until we know what the court order says about reimbursement of medical expenses.

 

[difficult3]

We are responsible for 70% of unreimbursed medical expenses. However, under PA Code this does not include cosmetic unless the specific expense was ordered by the court--which it was not. I'm just trying to see if orthodontic for cosmetic reasons could count anyway.

 

[ceara19]

We are responsible for 70% of unreimbursed medical expenses. However, under PA Code this does not include cosmetic unless the specific expense was ordered by the court--which it was not. I'm just trying to see if orthodontic for cosmetic reasons could count anyway.

I remember reading about a case where the NCP refused to pay for part of the child's braces due to the fact that they were cosmetic. The CP decided to take the matter to court. The CP successfully argued that braces were medically necessary for the child's MENTAL health because his crooked teeth made him subject to much ridicule by his peers.

 

[GrowUp!]

wow, this isn't going to be a legal answer, but I'm sorry I'm a cp and my son had an orthodontic procedure that is "cosmetic" and yes, I will make sure that the ncp pays his half.

And you have no legal authority to "make sure he pays his half." Especially if it's not in the court order.

would that child have been able to get that procedure had me and ncp been living under the same roof? yes, so why should it matter now?

How do you know that? You are simply assuming. It's alot easier to say that now...

personally I find that to be very insensitive not only on the cp but on the child as well.

And you're slightly biased, too.

my son was thrilled to get his teeth worked on because he kept talking about people with funny teeth and how they get laughed at.

Ummm...who's wouldn't be?

had this been plastic surgery then I'd understand. And I understand wanting documentation as to the amount but the other stuff.....

sorry, but it just smacks of being insensitive.

Insensitive my a&&. The fact is getting braces are cosmetic, no matter how much you or anyone else tries to argue it's not. Show me documention that if an individual doesn't get braces, they'll die.

I didn't think so.

And some orders address orthodontics and some do. Every other is different in their own way in regards to language.

 

[2boys]

Growup
I gave my opinion, plain and simple based on the only information that person decided to post. if she was late in giving all the facts, oh well, I gave my opinion based on what she posted. good thing is, you don't have to like my opinion.

 

[MrsK]

We are responsible for 70% of unreimbursed medical expenses. However, under PA Code this does not include cosmetic unless the specific expense was ordered by the court--which it was not. I'm just trying to see if orthodontic for cosmetic reasons could count anyway.

You may or may not be able to use this argument in court. I'd guess you'd need to talk to the ortho & get some sort of paperwork stating this was cosmetic and not neccessary, in case CP takes you to court.

Honestly, I dont think the "mental health" thing would fly with a lot of judges. Especially if you point out how many children CAN NOT get braces because their parents simply CAN NOT afford them- ever. I know a lot of people who never got these because their family was just too poor. I dont remember teasing these people, either, or these people jumping off the deep end b/c they were "ridiculed by their peers". Besides, kids will tease other kids over ANYTHING. If its not the braces, its the haircut, or the clothes, or whatever.

If this was truly cosmetic and it couldve waited a little while, I would refuse to pay and take my chances in court. If it goes to court, and you have to pay, well you arent really coming out with a worse outcome than going ahead & paying. Plus, CP may not feel like taking you to court & will leave it alone.

Quite honestly, if DH was in this situation (my husband has a kid & an ex) and CP did this cosmetically, we wouldnt pay right away. We'd wait for her to have it ordered that we HAD to pay, and try everything to prove it was cosmetic and therefore 100% her problem. Of course, I dont see this happening b/c @ this time she is 100% responsible for any uncovered medical expenses, and even if it did change, DH would be responsible for 50% at WORST and she'd never pony up 50% of money for braces. Maybe that sounds insensitive but when it comes down to paying for things that are NECCESSSARY (food, bills, etc) in my household and cosmetic braces for a child who doesnt live in my house...guess which one wins. Or, if it was like OP's situation and it came down to paying for cosmetic braces (that might not be their responsibility) or seeing my children, cosmetic braces still wouldnt win.

Also- I am curious- how old is this child?

 

[difficult3]

My stepson will be 9 next month.

Thank you for your support. It is very frustruating to always have to defend my husband because people tend to assume he is a deadbeat father and his ex is a poor struggling single mother. I always got great advice from this board and it is disheartening when people strike at you so quickly.