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Medically necessary orthodontics

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What is the name of your state (only U.S. law)? VA

My ex-husband and I share joint legal custody of our son, and I have primary physical.

We have known for several years that son (now 10) would need braces - in addition to crowding, one tooth grew in completely sideways, so it is physically obvious, but I have also emailed ex updates about it for at least 3 years, as I have received from dentist (such as - braces are in future but wait till all baby teeth out). All baby teeth now are, and so we went to orthodontist for a consult.

Son was diagnosed with cross bite, which is affecting his jawline and facial structure (visible difference in left and right sides, when looking at his jaw straight on, and you can see where the teeth in front and one side don't line up as they are supposed to). I assume that makes it medically necessary and not just cosmetic. He will need upper and lower braces for 20 - 24 months, as well as an expander for all of his teeth, but especially so that sideways tooth can fit in correctly.

After learning all this at the consult meeting, I called ex from the office to fill him in on everything, including cost ($5200) and the good news that all of son's issues will be resolved with the braces. He spoke to son too, everything seemed fine.

The ortho is in network and my current husband's insurance (we carry son) will pay $1500 lifetime, which ortho takes right off the top. I asked ex to set up an account to pay ortho directly his portion of approx $2400 (mine $1200 per court order of 66.7% him and 33.3% me; see below) - the ortho is willing to do monthly payments. I pay first $250 out of pocket each year, which has been met already in 2010, and offered to have ortho take my 2011 portion off balance and add to mine since January is so close.

Our CS order doesn't specify whether ex pays provider or me, or a time frame for reimbursement - just says "Mom shall provide health care coverage and Dad shall pay 66.7% of all unreimbursed health care expenses for said minor child, in excess of $250 per year. Mom shall pay the first $250 per year of unreimbursed health care expenses and 33.3% of all unreimbursed health care expenses in excess thereof."

My ex refuses to set up an account with the ortho to cover his portion, but didn't say how / when / if he's willing to cover percentage (his only response has been "The document I have shows that medical expenses kick in after $500.00 annually are spent. So based on the fact this will be spread out over the next 3 calender years, that gives a $1500.00 cushion before my obligation kicks in" but he's combining 2010, 2011, and 2012 and the $500 annually is not correct and never has been).

Bottom line, the only choice I see is to take on full responsibility and send him the receipts and ask him to reimburse me. I would have to set up monthly payments, so after the first $250 each year, I'd ask him for his 66.7% of each monthly payment (plus his portion of the required $800 down payment, in 2010).

VA code states "D. Except for good cause shown or the agreement of the parties, in addition to any other child support obligations established pursuant to this section, any child support order shall provide that the parents pay in proportion to their gross incomes, as used for calculating the monthly support obligation, any reasonable and necessary unreimbursed medical or dental expenses that are in excess of $250 for any calendar year for each child who is the subject of the obligation. The method of payment of those expenses shall be contained in the support order. Each parent shall pay his respective share of expenses as those expenses are incurred. Any amount paid under this subsection shall not be adjusted by, nor added to, the child support calculated in accordance with subsection G. For the purposes of this section, medical or dental expenses shall include but not be limited to eyeglasses, prescription medication, prosthetics, orthodontics, and mental health or developmental disabilities services, including but not limited to services provided by a social worker, psychologist, psychiatrist, counselor, or therapist. " ... so orthodontics is covered and our agreement matches this wording on the $250 - not sure what he is looking at or if he was just bluffing on the $500 but nothing we have ever had stated $500.

I shared with ex that if we went back to court and a judge did base our split on current income (which may or may not happen), our split could become 82/18 versus current 67/33 ... thinking it might nudge him. But currently we are under the 67/33 order so unless we go to court, that point is moot.

My questions are: It feels like this is what I should do - get treatment anyway since son needs it, and not wait for him to take responsibility. Am I not considering something I should?

On the reimbursements, can I scan and email him the bills, marked paid, or do they have to go registered mail? Should my note to him request reimbursement within 30 days? Can I assess late fees / interest if he doesn't pay, or is my only recourse taking him to court if he doesn't reimburse his portion? If I have to take him to court, should I wait a specific amount of time - ie, 60 days, 90 days, or longer? Would this be an issue that I could go pro se on? (Hate to do that but things are tight, and retainers are expensive)

Based on past experience, I suspect ex will simply ignore my requests for reimbursement and tell me I have to take him to court if I want him to contribute.

Sorry for the long post and thanks for your help - just want to be sure I handle things correctly and don't overlook something important. I have read through several others on this issue but would appreciate any thoughts.What is the name of your state (only U.S. law)?
 


mistoffolees

Senior Member
Until you've actually paid an expense and had ex refuse to pay, you can't do anything. He's only in contempt if he refuses to pay AFTER THE FACT.

The question will be whether they braces are medically necessary. It sounds like it to me, but I'm a layman so that's useless.

I would suggest:

1. Get a letter from the orthodontist stating that the braces are medically necessary.

2. Pay the bill.

3. Submit it to ex.

4. If he doesn't pay within a reasonable period of time, file for contempt.
 

aldaron

Member
"Son was diagnosed with cross bite, which is affecting his jawline and facial structure (visible difference in left and right sides, when looking at his jaw straight on, and you can see where the teeth in front and one side don't line up as they are supposed to). I assume that makes it medically necessary and not just cosmetic. He will need upper and lower braces for 20 - 24 months, as well as an expander for all of his teeth, but especially so that sideways tooth can fit in correctly."
You assume its not cosmetic, what does court order say about cosmetic issues and who pays. Sounds cosmetic too me and not medically necessary.
 
You assume its not cosmetic, what does court order say about cosmetic issues and who pays. Sounds cosmetic too me and not medically necessary.
I thought cosmetic would be like fixing a gap between two front teeth, not repairing an incorrect jawline. Our order doesn't differentiate between cosmetic and medically necessary at all, and neither does that section of Virginia code. I just mentioned it because apparently some orthodontics are strictly cosmetic and apparently some parents balk at paying it (or use it as a reason not to).

Thanks, mistoffolees - I hadn't realized that until there is an expense there is no obligation, but that makes total sense. I will assume responsibility at the orthodontist's office, request that letter just in case (if it's true of course) and request reimbursement for ex's percentage as I pay the bills.
 

nextwife

Senior Member
Out of curiousity, I certainly never considered proceeding with my daughter's orthodontia until I had obianed at least one second opinion. On something that costly and with that much difference of opinion on the "hows and whens" aspect, it seems the responsible thing to do. Did you consult with a second specialist? On something with this much OOP involved, I would hope so.
 
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Out of curiousity, I certainly never considered proceeding with my daughter's orthodontia until I had obianed at least one second opinion. On something that costly and with that much difference of opinion on the "hows and whens" aspect, it seems the responsible thing to do. Did you consult with a second specialist? On something with this much OOP involved, I would hope so.
Yes, thanks, this was our second opinion, slightly more cost effective, and also the ortho recommended by neighbors and co-workers.
 

mistoffolees

Senior Member
You assume its not cosmetic, what does court order say about cosmetic issues and who pays. Sounds cosmetic too me and not medically necessary.
It clearly sounds medically necessary to me, but since neither of us is a licensed orthodontist (or, if you are, you haven't examined the patient so your opinion wouldn't matter, anyway), let's leave it for the experts. She needs a determination from an orthodontist who has examined the child as to whether it's necessary.
 
VA Mom,

Once the Orthodontist has seen son and has deemed it medically necessary than appliances need to be placed (headgear, retainers, actual brackets ) have him write a prescription or letter up stating what the treatment plan is, submit that to Ex. Better yet is to have Ex accompany son and you to next visit and have Ortho explain it to him. Then with both parents there see the financial manager of office and do a break down for EX. If EX refuses to comply, I would start treatment, then file in court for him to pay, at JDR court, I know our Judges in my area of VA, will want to see Orthos statement of treatment, final costs broken down, and will normally order EX to pay within certain time frame. I did mine pro se, just brought everything let Judge look at it completely broken down and he ordered my EX to pay and that he will pay timely or he would increase child support to accomodate payments.
 

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