Recently, I took my twin five year old boys to the doctor for their pre-Kindergarten check-up. The co-pays were $30.00 each and my younger twin (by 1 minute) also needed his prescription filled, which cost $12.00. I am so grateful for how far my twin boys have progressed and how much their expenses have decreased. My boys were born at 32 weeks and their hospital bills including NICU stays totaled over one-half million dollars! Fortunately, our responsibility was less than one percent, but we still owed the hospital tens of thousands of dollars! We knew that we could not afford to pay the bill in full so, we negotiated a payment plan to pay. Reminiscing regarding these costs made me think of all of my clients who have had to file motions to obtain reimbursement from the other parent for unreimbursed medical costs. I want to provide divorced, separated or never married parents with a guide to best practices for receiving reimbursement of their children’s uncovered medical expenses.

First, child support does not include “reasonable and necessary unreimbursed medical and dental costs.” Pursuant to the Virginia Child Support Guidelines, these costs are in addition to any other child support obligations. Normally, these costs are paid “in proportion to [the parent’s] gross incomes” § 20-108.2.D.

Second, what are medical and dental expenses? The Virginia child support guidelines have defined these terms expansively stating “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.” If a doctor, dentist, therapist, optometrist or other medical professional determines that your child needs the treatment; then, it is likely that the court would require the other parent to contribute to the expenses.  UPDATE:  In 2020, 20-108.2.D1 was added to include birth related expenses.  Specifically, the provision provides: “Every Initial order in a child support proceeding commenced within six months of the birth of a child, except for good cause shown or the agreement of the parties, in addition to any other child support obligations established pursuant to this section, the 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 unpaid expenses of the mother’s pregnancy and the delivery of such child.”

Third, if your child is going to incur substantial medical or dental expenses, you should advise the other parent that these costs are going to be incurred and the costs per session or treatment, if known. This forewarning is not only important to co-parenting, but will also provide additional evidence of your reasonableness and notification to the other parent. Moreover, it may be beneficial to both parents to obtain a payment plan that may be shared in the case of large expenses whether expected or unexpected.

Next, here are the top reasons that Virginia courts deny reimbursement or attorney’s fees in a contempt action for reimbursement of medical or dental expenses.

The party failed to provide:

  • Proof of expense – The parent failed to provide sufficient proof of the expense; A credit card receipt for $30.00 at Dr. Miller’s office does not suffice if he sees adults and children; A print out from Dr. Miller’s office showing patient and appointment type with a credit card receipt would usually be sufficient; Best practices would be a print out from Dr. Miller’s office, credit card receipt and the explanation of benefits showing that the $30.00 was patient’s responsibility, copay or similar language; Provide the explanation of benefits to ensure that the amount due was not subsequently reimbursed by insurance.
  • Proof of payment – The parent failed to provide proof to the Court that they provided sufficient proof of payment to the other parent (i.e.:. cancelled check, credit card receipt, cash receipt, etc.).
  • Proof of request – The parent failed to provide proof to the Court that they requested payment and provided the proof of expense and proof of payment; If sending e-mail, use the same or similar e-mail subject (ie: Medical Expense Reimbursement) in order to make any search for providing evidence more efficient and organized. A parent could also make a separate folder for these e-mails and any responses; In addition to e-mail, the parent should consider sending all of the documents via regular and certified mail along with the excel spreadsheet showing the total amounts due and owing. The other parent has an obligation to the Court to provide his/her change of address, but no similar obligation exists regarding e-mail.
  • Reasonable time for reimbursement – The parent failed to allow a reasonable time for reimbursement (30 days is customarily reasonable) depending on the amount of the reimbursement; The terms of the parties’ agreement controls if it is specifically addressed. If it is not addressed; then, reasonable will be decided by the Court and the parent should ask the Court to provide a specific time for reimbursement in the future; If the amount is substantial or greater than the monthly child support amount, the parent may offer a payment plan wherein the other parent could pay $x per pay period or month towards the total amount due; and The parties may share in any payment plan negotiated in with the service provider.
  • Optional – spreadsheet of payments due, payments made and amounts still due and owing; This is another example of best practices which are not necessary, but provide another level of documentation and evidence for the Court.

Today, parents can download an app on their smartphones that allows them to scan the proof of the expense and the proof of the payment immediately. The app also allows them to e-mail directly from the app. I use DocScan, but there are lots of other good options. A simple app could provide the necessary documentation for 1-3 above.

Below is a spreadsheet for the “Anderson” family who have two children, Jack and Jill. The mother has failed to provide her portion of the expenses.

Date of Treat
Name of Provider Child Type Amount of Expense Percent
age due
Amount Due Amount Paid Payment Date/
Amount Remain
Date of Request Form of Request Deadline
3/20/17 Inova Hospital Jill ER/deduct
$1,100.00 0.6 $660.00 $300.00 4/1/2017 Check $360.00 3/25/17 E-mail w/attachments 4/25/17
4/20/17 Dr. Williams Jill Surgeon $700.00 0.6 $420.00 $200.00 4/15/17 Cash $220.00 4/25/17 E-mail w/attachments 5/20/17
5/5/17 Dr. Patel Jack Deductible $100.00 0.6 $60.00 $0.00 $60.00 5/30/17 E-mail w/attachments 6/21/17
6/3/17 Dr. Johnson Jill Copay $30.00 0.6 $18.00 $0.00 $18.00 6/30/17 E-mail w/attachments 6/28/17
7/1/17 Dr. Smith Jill 10% unpaid $275.00 0.6 $165.00 $0.00 $165.00 7/26/17 E-mail w/attachments 8/26/17
7/4/17 Dr. Miller Jack Copay $30.00 0.6 $18.00 $0.00 $18.00 7/26/17 E-mail w/attachments 8/26/17
$2,235.00 $1,341.00 $500.00 $841.00

The above provide some suggestions in order to have the best chance for the Court to not only enforce the other parent’s obligation to pay unreimbursed medical and dental expenses, but also to award attorney’s fees for collection and enforcement.

Finally, parents do sometimes have legitimate differences in opinion whether a procedure or therapy is medically necessary, whether the time to repay is reasonable or whether an expense is accurate. These discussions should be in writing as much as possible in order to allow an attorney to advise them as well as demonstrate to the Court the steps that the parent has taken to accommodate the other parent.

When considering whether to hire an attorney to pursue medical reimbursement, it is important to consider the total costs. On the other hand, parents need to make sure that they are not waiting too long as their claim for reimbursement may be waived. Moreover, hiring a Virginia divorce attorney for a medical reimbursement claim may be fiscally irresponsible if the parent spends more on attorney’s fees than received in reimbursement. Therefore, it is essential that the chances are maximized that the other parent will be held in contempt for non-compliance and be responsible for attorney’s fees as well.

Please e-mail with the subject Medical Spreadsheet if you would like a copy of the spreadsheet above which can be tailored to your own family.

Divorce Lawyers in Virginia

Contact us today to speak with one of our Fairfax County or Prince William County divorce attorneys located in Fairfax and Manassas if you would like a consultation regarding your claim for medical and dental reimbursements for your children or how to file for divorce in Virginia, including getting child support, spousal support, or custody. Read more about how we have helped our clients here.