COURT OF COMMON PLEAS

DOMESTIC RELATIONS SECTION

Mailing Address:

Dauphin County Court House, Box 1295, Harrisburg, PA 17108

KIM S. ROBISON

Director

SHEILA D. BRITT, ESQ.

Assistant Director

(717) 255-2796

(717) 780-6848 Fax

(717) 780-6849 Fax

JEANNINE TURGEON

Judge

vs.

Docket No: PACSES Case No:

Dear :

In response to your request for enforcement action, you must first have a court order that entitles you to seek reimbursement for unreimbursed medical expenses. If court ordered, you may be legally responsible to pay the first $250 annually per person of unreimbursed medical expenses before you can seek payment from the other party. This $250 annual expense shall be prorated for the year in which the support order is effective, thereafter, on an annual basis, January through December. The excess unreimbursed medical expenses are not assumed entirely by the other party, but these expenses are shared between both parties in proportion to the parties’ net incomes (as stipulated in your Order of Support).

Not all medical expenses are reimbursable under the law. The Pennsylvania Rule of Civil Procedures 1910.16-6(c)(1)-(3), considers medical expenses as annual unreimbursed medical expenses in excess of $250 per person per year. Medical expenses include insurance co-payments and deductibles and all expenses incurred for reasonably necessary medical services and supplies, including but not limited to surgical, dental and optical services, and orthodontia. Medical expenses do not include cosmetic, chiropractic, psychiatric, psychological or other services unless specifically directed in the order of court. Thus, before seeking reimbursement, you should carefully review the specific language in your court order concerning unreimbursed medical expenses to recognize the expenses that qualify for reimbursement under the law.

Additionally, the law regarding medical reimbursement was amended effective October 17, 2006, (Pa. R.C.P. 1910.16-6(c)(3)). The law requires that the party seeking payment for unreimbursed medical expenses provide documentation to the other party no later than March 31 of the year following the calendar year in which the party seeking payment received the final bill. Enforcement of unreimbursed medical expenses not timely provided by the party seeking payment shall be within the discretion of the court.

In order to process your request, you must comply with the enclosed “Medical Enforcement Procedure.” You can contact me with any questions at (717) 255-2796.

Sincerely,

Enclosures

cc: File	EN024C

Medical reimbursement procedure

Responsibility of the party seeking reimbursement

To collect payment for your court ordered unreimbursed medical expenses, you must follow the below Dauphin County Domestic Relations procedures:

Adhere to your insurance company’s rules and submit bills/claims for processing. Note: If you fail to follow your insurance company’s rules and your bill/claim is denied by the insurance company, the other party may not be responsible for the proportionate share of that cost.

After the insurance company pays the allowable coverage of the bill/claim and sends you the insurance statement of the balance owed, determine the new balance due for the respective bills. Determine the balance owed by both parties based on the percentage share referenced in your court order of support.

Pay all bills in full and send written notification to the other party of his/her share of the exact amount owed for reimbursement. With the notification, include copies of the medical bills and the insurance statement of the balance owed that proves you met your annual unreimbursed medical expenses in excess of $250 per person (if you are court ordered to pay these expenses). These documents must be sent to the other party by certified mail with proof of delivery (green card must be signed).

If the other party fails to reimburse you within 30 days or you are unable to serve the other party, complete the enclosed medical enforcement form and payment verification form (both forms must be signed and dated). Send these completed forms and copies of all documents to our office (including proof of successful service and unsuccessful service attempts).

All forms and documents must be mailed to the DRO no later than June 1 for the previous year’s unreimbursed medical bills.

Responsibility of the party making payment

The other party must pay his/her share of the unreimbursed medical expenses within 30 days of notice and receipt of the above-required documents.

The other party must make the reimbursement directly to the party seeking reimbursement. This reimbursement payment must NOT be paid to the Domestic Relations Office or PA SCDU.

Domestic Relations Enforcement

Upon receipt of the completed forms, documents, and proof of service or attempted service, the DRO will review the information for compliance with the above-procedures. The DRO will schedule an enforcement conference with the responsible party or both parties, when applicable, to make payment. Thus, the plaintiff may be required to appear.

The party seeking reimbursement should contact the DRO to determine the results of the enforcement conference.

After the enforcement conference is held and if the medical bills are not reimbursed, additional enforcement action will be taken, including but not limited to Contempt of Court proceedings.

EN024C

PAYMENT VERIFICATION FORM FOR

THE FIRST $250 ANNUAL, PER PERSON, UNREIMBURSED MEDICAL EXPENSES

* If court ordered, this form must be completed so the DRO can verify that you have met this expense.

You may make copies of this form as needed. Use one form per person.

Name of Patient for these expenses: __________________________________

Relationship: Child Self

Date of service	Type of service	Total Bill	Insurance Payment	New Balance	Amount paid to provider	Date payment made

TOTAL PAYMENT TO THE PROVIDER FOR THIS PAGE: $_________________________

I, ________________________, verify that the facts set forth in the foregoing payment verification form, including all attachments thereto, are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to penalties of 18 Pa. C.S. Section 4909 relating to unsworn falsification to authorities.

Date: _________________________________	EN024C

EF-M27

Signature: _____________________________

MEDICAL ENFORCEMENT FORM

Case_______________________________ Plaintiff ________________________________ vs. Defendant ________________________________

Date of service	Type of service	Name of Patient	Total bill	Insurance payment	(new) balance after payment	Date other party notified	Defendant balance	Plaintiff balance
I, ________________________, verify that the facts set forth in the foregoing medical enforcement form, including all attachments thereto, are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to penalties of 18 Pa. C.S. Section 4909 relating to unsworn falsification to authorities.

Date: _________________________________

Signature: _____________________________

EN024C

EF-M28

Dauphin County Domestic Relations Section, Human Services Building, 25 S. Front Street, Harrisburg, PA 17101

COURT OF COMMON PLEAS

doyleha

2016-10-03

Dauphin County